Final BladderPath data back MRI MIBC staging
By Kayla Lee
The final survival analysis of the BladderPath trial supports use of a magnetic resonance imaging (MRI)-based diagnostic pathway for patients with suspected muscle-invasive bladder cancer (MIBC), report investigators at the European Society for Medical Oncology (ESMO) Congress 2025.
Presenter Nicholas James (Royal Marsden Hospital, London, UK) reminded delegates that they previously reported a greater than 30-day reduction in the time between first outpatient appointment and receipt of correct treatment for patients with suspected MIBC who received MRI ahead of TURBT. Currently, patients often wait more than 100 days, he said.
A total of 143 patients were randomized: 72 to the TURBT-staged pathway and 71 to the MRI-staged pathway.
James noted that the trial was “sadly underpowered” for survival outcomes, due to stalled recruitment during the pandemic. Although there was a reduction in progression-free survival (HR, 0.75) with the MRI versus TURBT pathways, this was not statistically significant.
Nevertheless, there was a statistically significant improvement in bladder cancer–specific survival for patients in the MRI arm, with an HR of 0.36 (95% CI, 0.135–0.98; P=0.046) and a “very clear and obvious and early separation” of the survival curves.
“We think this is potentially very important indeed,” said James.
While overall survival also favored the MRI pathway (HR, 0.67), the difference did not reach statistical significance (P=0.252). However, James stressed that the effect of the staging pathway was diluted by the number of deaths from other causes – approximately half the patients died from causes other than bladder cancer. He also observed that “when we break it down, we’ve still got an advantage in the muscle-invasive bladder cancer patients,” albeit not significant.
Importantly, James noted that there was no evidence of misdiagnosis and detriment to outcomes from the MRI-based approach across any of the key metrics, which he said had been a point of potential concern.
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