Automatic detection method of bladder tumor cells based on color and shape features

Bladder urothelial carcinoma is the most common malignant tumor disease in urinary system,and its incidence rate ranks ninth in the world.In recent years,the continuous development of hyperspectral imaging technology has provided a new tool for the auxiliary diagnosis of bladder cancer.In this study,based on microscopic hyperspectral data,an automatic detection algorithm of bladder tumor cells combining color features and shape features is proposed.Support vector machine(SVM)is used to build classification models and compare the classification performance of spectral feature,spectral and shape fusion feature,and the fusion feature proposed in this paper on the same classifier.The results show that the sensitivity,specificity,and accuracy of our classification algorithm based on shape and color fusion features are 0.952,0.897,and 0.920,respectively,which are better than the classification algorithm only using spectral features.Therefore,this study can effectively extract the cell features of bladder urothelial carcinoma smear,thus achieving automatic,real-time,and noninvasive detection of bladder tumor cells,and then helping doctors improve the efficiency of pathological diagnosis of bladder urothelial cancer,and providing a reliable basis for doctors to choose treatment plans and judge the prognosis of the disease.

Results of Trans-Urethral Resection of Bladder (TURB) for the Treatment of Non-Infiltrating Bladder Tumors (NMIBT) in Musk in Bouake

Background: bladder tumors rank 2nd among urological tumors in sub-Saharan Africa, particularly in Côte d’Ivoire. Objective: to report the results of transurethral resection of the bladder (TURB) for the treatment of non-muscle-infiltrating bladder tumors (NMIBT) in Bouaké. Patients and methods: we conducted a cross-sectional, descriptive study of transurethral resection of the bladder (TURB) for the treatment of non-muscle-infiltrating bladder tumors (NMIBT) between January 2022 and April 2023. All patients and their families were informed in advance and had signed an informed consent form. All patients with a non-muscle-invasive bladder tumor confirmed by an initial TURB were included, and patients with a bladder tumor infiltrating the bladder muscle were excluded. Diagnosis was based on cystoscopy and anatomopathological examination of resection shavings. Parameters studied were: age, sex, risk factors, reason for consultation, clinical signs, cystoscopy findings, stage, grade, Evolution. Results: 17 patients with a mean age of 53.7 years (22-73 years) underwent trans-ureteral bladder resection to treat a non-muscle-infiltrating bladder tumor (NMIBT). Male gender predominated with 88.23% (n = 15), the majority of patients came from the ME region with 47.05% (n = 8), farmers were the most numerous (52.94%;n = 9). The most frequent reason for consultation was macroscopic hematuria with 64.1% (n = 11), risk factors were dominated by urinary bilharziasis with 70.58% (n = 12), physical examination was normal in 47.05% (n = 8). Hemoglobin (HB) levels were between 7.5 and 8.5 g/dl in 52.94% (n = 9). On cystoscopy, the tumor was budding in 76.45% (n = 13), the localization was trigonal in 52.9% (n = 9) and the base of implantation was sessile in 70.52% (n = 12). On ultrasound, the tumor was 3 cm or larger in 70.52% (n = 12). Therapeutically, 82.35% (n = 14) of patients received a blood transfusion. TURB was complete in the majority of cases 88.23% (n = 15). Squamous cell carcinoma was the most frequent histological type with 76.47% (n = 13). PTa and PT1 grade accounted for 23.52% (n = 4) and 76.47% (n = 13) respectively. High-grade PT1 accounted for 64.70% (n = 11). Follow-up to TURB was straightforward in 94.11% (n = 16). At three months post-TURB, seven patients presented a tumor recurrence, with 41.17% (n = 7) requiring a second TURB. At 6 months, follow-up noted 14 patients free of any clinical or endoscopic signs of bladder tumors. Conclusion: TURB is a safe and effective means of treating non-muscle-invasive bladder tumors.

Comparisons of voided urine cytology, nuclear matrix protein-22 and bladder tumor associated antigen tests for bladder cancer of geriatric male patients in Taiwan, China

Aim： To compare the results of bladder tumor associated antigen （BTA TRAK）, nuclear matrix protein 22 （NMP 22） and voided urine cytology （VUC） in detecting bladder cancer. Methods： A total of 135 elderly male and 50 healthy volunteers enrolled in this study were classified into three groups： （i） 93 patients with bladder cancer; （ii） 42 patients with urinary benign conditions; and （iii） 50 healthy volunteers. BTA TRAK and NMP 22 kits were used to detect bladder cancer. Voided urine cytology was used to compare the sensitivity and specificity of the screening tests. Results： The sensitivity and specificity of cytology, BTA TRAK and NMP 22 were 24% and 97%, 51% and 73%, 78% and 73%, respectively. The level of NMP 22 increased with tumor grading. The BTA TRAK kit has the lowest sensitivity among the screening tests. The NMP 22 with the best sensitivity can be an adjunct to cytology for evaluating bladder cancer. Conclusion： The NMP 22 test has a better correlation with the grading of the bladder cancer than BTA TRAK. As cytology units are typically not available in hospitals or in outpatient clinics, NMP 22 might be a promising tool for screening bladder cancer.

Total intravenous general anesthesia with laryngeal mask airway for transurethral resection of bladder tumor

Objective： To observe the advantage of total intravenous anesthesia for transurethral resection of bladder tumor （TURBT）. Methods.. Sixty ASA Ⅰ-Ⅱ patients undergoing TURBT were randomly assigned to 2 groups. Spinal anesthesia with 0. 75% pure bupivacaine （8-12 rag） was applied to patients in Group Ⅰ （n= 30）. Patients in Group Ⅱ （n=30） received total intravenous anesthesia with continuous infusion of Propofol and Remifentanil ; and a laryngeal mask was used to ensure the airway and ventilation. BP, HR, SPO2 and pertinent side effects were monitored and recorded. Results ： The patients in group Ⅱ experienced more stable hemodynamics than those in group Ⅰ . Obturator nerve reflex was observed in 15 （50. 0%） patients in Group Ⅰ , but none （0%） in Group Ⅱ （P〈0. 01）. Conclusion.. Total intravenous anesthesia with laryngeal mask is a safe, reliable, controllable and simple manual for patient undergoing TURBT.

Cytotoxic T-lymphocytes response in vitro activated by dendritic cells pulsed with heat shock protein 70 derived from human bladder tumor cell lines of EJ

Objective： To investigate whether human dendritic cells （DC） derived from peripheral blood mononuclear cells （PBMC）, which were pulsed by heat shock protein 70 （HSP70） isolated from human bladder tumor cell lines of E J, were able to induce peptide specific cytotoxic T-lymphocytes （CTL） response in vitro and give the experimental foundation for the future clinical trials of immunotherapy in bladder tumor. Methods： The E J-derived HSP70 co-cultured with DC from the healthy volunteers＇ PBMC, along with the crude lysate （the supematant before HSP70 purification） from EJ cells were used as the experimental groups and DC not pulsed by any tumor cells antigen were the blank control. The autologous T-lymphocytes were added into the above various DC groups, and after incubation, the stimulation indexes （SI） and interferon-y （IFN-γ） were detected to evaluate the immune activities of various DC groups. The killing effects of CTL to target cells, EJ and Hela cells, were determined with 51^Cr releasing test. Results： Both DC/HSP70 and DC/the crude lysate could effectively activate CTL in vitro and kill target cells EJ. The killing effect of DC/HSP70 to EJ was much stronger than DC/the crude lysate （the supernatant before HSP70 purification） （P 〈 0.05）. DC without any tumor cell antigens had a lower killing power to EJ. Meanwhile, DC/ HSP70 had little killing power to Hela non-relevant to bladder tumor histopathologically as compared with EJ cells （P 〈 0.05）. Conclusion： The DC pulsed by HSP70 derived from the autologous tumor cells could induce a peptide complexes specific CTL response to tumor cells, and the CTL response induced by the DC/HSP70 was stronger, which display the basis of the possible clinical application of DC/HSP70 for bladder tumor.

An Unusual Paraneoplastic Syndrome of Synchronous Bladder Tumor and Prostate Cancer: Polymyositis

Introduction: Polymyositis (PM) is a type of inflammatory myopathy that is associated with a broad range of malignant disorders. An association of PM with synchronous carcinoma of the bladder and prostate is extremely rare. Case: A 65-year-old man admitted to hematology with complaints of severe progressive weakness of lower extremities, hematuria and irritative urinary symptoms lasting for a month. The hemogram and erythrocyte sedimentation rate were normal. ALT was normal but AST was 405.56 U/l. There was marked elevation of serum creatine kinase (CK) and lactate dehydrogenase, which were 14,065.15 U/l and 1267.50 U/l, respectively. PSA was 4.28 and DRE was positive. The abdominal ultrasound revealed a 24 × 20 mm soft tissue echogenicity lesion at the right wall and a 35 × 21 mm soft tissue echogenicity lesion at the left wall of the bladder. The rest of the abdominal viscera were normal. Computed tomography found, two 6 mm solid lesions at left anterolateral and a 18 × 12 mm solid lesion at inferoanterior bladder wall in addition to the above findings. Patient counseled to us. We resected all of the bladder masses with transurethral (TUR-BT) way and pathology revealed T2 high grade bladder tumor. Two days after TUR-BT, we performed a trans rectal ultrasonography guided prostate biopsy and pathology revealed a Gleason 3 + 4 prostate cancer. EMG showed sensorimotor polyneuropathy at the lower extremities, sustaining polymyozitis. Biopsy of the right peroneus brevis muscle showed no vasculitis with low grade neurologic changes. We offered to perform a radical cystoprostatectomy operation but the patient prefered chemotherapy. Two months after his initial presentation at the second cure of the chemotherapy all muscle weaknesses showed a dramatic regression. Conclusion: This case report indicates that both bladder carcinoma and prostate cancer should be kept in mind in elderly PM patients presenting with lower urinary tract symptoms and hematuria.

Detection of Serum Hyaluronic Acid and Laminin in Patients with Bladder Tumors

In order to investigate the changes of serum hyaluronic acid (HA) and laminin (LN) le-vels and their clinical implication in the patients with bladder tumors, the serum HA and LN levels in 34 patients with bladder tumor and 30 cases of control group were detected by radioimmunoassay before and after operation. The results showed that the serum HA and LN levels in the patients with bladder tumors were significantly higher than those in control group (P<0.01) before operation, and decreased significantly after operation (P<0.05). The serum levels of HA and LN in infiltration tumors were higher than those in superficial tumors (P<0.05). The serum HA and LN levels in patients with lymph node metastasis were higher than those without lymph node metastasis (P<0.01). The investigation revealed that HA and LN might be involved in the malignant biology behavior of bladder tumors and could be used as important markers of assistant diagnosis and condition monitoring.

Application of ^(18) F-FDG PET/CT Imaging in Diagnosing Bladder Tumor Metastasis Lesions

Bladder tumor is the most common malignant tumor in urinary system and always com- panied with lymph node metastasis. The accurate staging plays a significant role in treatment for bladder tumor and prognostic evaluation, and the distant metastasis predicts worse prognosis. The objective of this study was to assess the clinical significance of 18F-FDG PET/CT imaging in diagnosing bladder tumor metastasis lesions. A retrospective analysis of 60 patients with bladder tumor from October 2008 to May 2010 was done. The patients were stratified based on the imaging technique. Among all 60 cases, besides the primary lesion, 81 suspected lesions were spotted and 73 confirmed as metastasis, including 50 lymph node metastases, 22 distant metastases, and 1 bone metastasis. For PET/CT imaging, its sensitivity was 94.5%, specificity 87.5%, positive predictive value 98.6%, negative predictive value 63.6% and accuracy 93.8% respectively. For CT, its sensitivity was 82.2%, specificity 50%, positive predictive value 93.8%, negative predictive value 23.5% and accuracy 79% respectively. PET/CT im- aging was superior to CT in sensitivity, specificity and accuracy. In conclusion, 18F-FDG PET/CT imaging is more significant in diagnosing bladder tumor metastasis lesions.

RELATION BETWEEN MORPHOMETRIC GRADES OF BLADDER TUMOR AND PROGNOSIS

The relation between morphometric grades (M grading) of 84 cases of bladder tumor and prognoses was evaluated. The results shown that the higher the M grading, the lower the survival rate and the higher the recurrence rate. As the M grade increases, the tumor has partial of total absence of ABO(H) antigens of tumor cell surface and could be accompanied with muscular invasion. When recurring, the tumor has a poor prognosis if M grading increases from lower to higher grades. The morphometric grading system is able to make a quantitative pathologic diagnosis and can predict the biological behavior of bladder tumors.

THE CLINICAL SIGNIFICANCE OF FLOW CYTOMETRIC DEOXYRIBONUCLEIC ACID MEASUREMENT OF DEPARA-FFINIZED SPECIMEN IN BLADDER TUMOR

A retrospective study of flow cytometric measurements on paraffin-embedded tumor specimens from 188 patients with bladder tumor was conducted. The results were analyzed in combination with the morphological variation of bladder tumors. It was found that the DNA ploid pottern, degree of infiltration and the multiplicity of bladder tumor were closely related with tumor recurrence, among which the DNA ploid pattern was most significant. In aneuploid bladder tumors the recurrent rate and mean annual recurrence frequency were 76.7% and 1.46, and those in the diploid bladder tumors were 18.7% and 0.33 respectively. Aneuploid was the most indicative parameter of the recurrence in bladder tumors. In addition, according to the DNA ploid pattern and DNA index (DI), the aneuploid tumors in our group were divided into 4 types, namely, tetraploid tumors, npn-euploid with DI(?)1.5, non-euploid tumors with DI>1.5 and two-aneuploid tumors. The results showed that the recurrent rate of tetraploid tumors was relatively lower and it became higher and higher in the following order: non-euploid tumors with DI(?)1.5, non-euploid tumors with DI>1.5, and two-aneuploid tumors. This indicates that there are different biological behaviors in tumors with different ploid pattern. Finally, the correlation between DNA ploid pattern and tumor metastasis was also discussed.

Intravesical explosion during transurethral resection of bladder tumor:A case report

BACKGROUND Intravesical explosion during transurethral resection of bladder tumor(TUR-BT)is a very rare complication,and it may result in rupture of the bladder,which usually requires surgical correction and causes a potential threat to the patient’s life.CASE SUMMARY This paper reports a case of intravesical explosion during TUR-BT.Combined with the literature review,the risk factors are analyzed and measures of prevention and treatment are discussed.CONCLUSION Although rare,intravesical explosions can cause serious consequences,and the loud explosion can also lead to a profound psychological shadow on the patient.Urologists must be aware of this potential complication.Careful operative techniques and special precautions can reduce the risk of this complication.

An Inhibitory Effect of MAD1 on Bladder Tumor Cellular Proliferation in Vivo

OBJECTIVE To observe the inhibitory effect on bladder tumor proliveration after transfection with the expression plasmid pcDNA3.1（＋）/Madl. METHODS Bladder tumors were induced in SD rats by intravesical instillation of MNU . The tumor-bearing rats were randomly divided into 3 groups： group A, transfected with pcDNA3.1 （＋）/Mad1, group B, transfected with an empty vector and group C, transfected with saline. Rat body weight （RBW）, bladder absolute weight （BAW） and bladder relative weight （BRW） were measured and expression levels of Mad1 and TERT were assayed. Flow cytometer analysis was used to observe the effect of Mad1 on the bladder tumors. RESULTS Comparions of RBW among the 3 groups showed there were no differences （P〉0.05）. But the BAW and BRW for group A were significantly decreased （P〈0.01, P〈0.05, respectively） comparded to groups B and C. In group A, the Mad1 mRNA expression level was markedly improved, while the TERT mRNA expression level was decreased. Flow cytometry showed an increase in GJG1-phase cells and a decrease of Sphase cells after transfection with Mad1. CONCLUSION Over expression of Mad1 can inhibit the cellular proliferation of bladder tumors.

The practical value of 3-dimensional computed tomography on diagnosis of bladder tumor

Objective To study the practical value of 3-dimensional computed tomography on diagnosis of bladder tumor, Methods Fifteen patients with bladder masses were examined by thin-layer computed tomography. The results of 3-dimensional reconstructed images were compared with the final diagnosis and the pathological stages. Results According to 3-dimensional reconstructed images, among the 15 cases, 12 cases of bladder cancer were diagnosed, and the pathological types were transitional carcinoma. Two cases were diagnosed as benign tumor (leiomyoma), and the other one was colon cancer, which invaded bladder. The accuracy was 100% . The clinical stages were determined. Of the 12 bladder carcinomas,5 was in stage T1, 3 in T2,, 3 in T3 and 1 in T4.The accuracy of staging was up to 83% (10/12) compared with pathological stages. Conclusion The 3-dimensional reconstructed technology may improve the accuracy of staging of bladder carcinoma, and to provide important evidence for surgery options. 3 refs,2 figs.

Intra-Diverticular Bladder Tumor about a New Observation in the Urology Department of Chu Cocody—Abidjan, Côte d’Ivoire

This case report is about a 61 years old woman who consulted for hematuria, the cystoscopy performed revealed an intra-diverticular bladder tumor. After tumor resection, an anatomopathological exam revealed the urothelial carcinoma pT1. A few months later she presented with a local reccurence of bladder tumor. We proposed her anterior pelvectomy but she refused it and she was lost to follow-up. The aim of this study is to show the anatomopathological and evolutionary characteristics and the therapeutic difficulties of IDBT. These tumors are in the majority of cases infiltrating from the outset with a high potential for recurrence after transurethral resection of bladder (TURB). The standard treatments are TURB and total cystectomy.

Cryoablation techniques in bladder cancer: A review

Bladder cancer(BC)ranks as the tenth most common cancer globally.Histopathologically,BC is broadly categorized into urothelial and non-urothelial BC.Urothelial carcinoma represents over 90%of BC in most regions worldwide.The standard treatment procedure for diagnosing and treating non-muscle-invasive bladder cancer(NMIBC)is transurethral resection of bladder tumors(TURBT).Currently,the standard of care for muscle-invasive bladder cancer(MIBC)is neoadjuvant chemotherapy followed by radical cystectomy.Cryoablation therapy is a medical technique that uses extremely low temperatures to destroy diseased tissue.This treatment serves as a therapeutic tool for both benign and malignant diseases in organs such as the kidney,prostate gland,lung,liver,and breast,and is particularly effective for unresectable tumors,offering less trauma,quick recovery,good tolerability,and symptom control.However,cryoablation has its limitations.Over the past few years,cryoablation therapy has emerged as a new method for treating early BC.This treatment is minimally invasive,precise,and offers quick recovery,providing patients with a new treatment option.Although randomized studies are still limited,increasing evidence suggests its potential application in bladder cancer combined with transurethral resection(TURBT)or medication.Cryoablation is not standard therapy for bladder cancer.Treatment decisions should be discussed by a multidisciplinary team of urologists,oncologists,and interventional physicians and require more randomized controlled trials to define patient selection criteria and treatment approaches.

Primary large cell neuroendocrine carcinoma of the bladder:A case report

BACKGROUND Large cell neuroendocrine carcinoma(LCNEC)of the bladder is a rare nonurothelial tumor of the bladder.The treatment of LCNEC of the bladder is different from that of urothelial carcinoma(UC);therefore,early and accurate diagnosis is particularly important.As LCNEC of the bladder is rare and its clinical symptoms and radiographic features are similar to those of urothelial tumors,the clinical diagnosis of the disease remains challenging.CASE SUMMARY We report a 72-year-old female patient who presented with gross hematuria for 3 mo.A solitary tumor located in the anterior wall of the bladder was found by cystoscopy.Pathological examination after biopsy suggested UC of the bladder in the absence of immunohistochemical assessment.The patient underwent partial cystectomy and was finally diagnosed with LCNEC(pT2bN0M0)based on the results of postoperative immunohistochemical examination.During the 10-mo follow-up,no signs of tumor recurrence or metastasis were found.CONCLUSION Immunohistochemical examination is essential for diagnosing LCNEC of the bladder.Accurate diagnosis and multidisciplinary treatment in the early stage of the disease are crucial for improving the prognosis.

Holmium laser versus conventional transurethral resection of the bladder tumor

Background Transurethral resection of the bladder tumor （TURBT） remains the gold standard for non-muscle-invasive bladder cancer （NMIBC）. Laser techniques have been widely used in urology. This analysis aimed to assess the safety and efficacy of holmium resection of the bladder tumor （HoLRBT）vs. TURBT. Methods A systemic search of MEDLINE, Embase, Web of Science, and The Cochrane Library as well as manual bibliography searches were performed to identify the relevant studies. The pooled estimates of operation time, obturator nerve reflex rate, bladder perforation rate, bladder irrigation rate, catheterization time, hospital stay, and one- and two-year recurrence free survivals were calculated. Results Five studies were enrolled into our meta-analysis. No significant difference was observed in the operation time between groups （weighted mean difference （WMD） 1.01, 95% confidential interval （95% CI） -3.52-5.54, P=0.66）. The significant difference in the obturator nerve reflex （OR 0.05, 95% CI 0.01-0.04, P=0.004）, bladder perforation （OR 0.14, 95% CI 0.03-0.61, P=-0.009）, bladder irrigation （OR 0.13, 95% CI 0.04-0.45, P=0.001）, catheterization time （WMD -0.96, 95% C1-1.11 to-0.82, P 〈0.00001）, and hospital stay （WMD-1.46, 95% C1-1.65 to-1.27, P 〈0.00001）showed advantages of HoLRBT over TURBT. The 2-year recurrence free survival rate favors the HoLRBT group （OR 1.46, 95% CI 1.02-2.11, P=-0.04）. Conclusions As a promising technique, HoLRBT is safe and efficient, and showed several advantages over TURBT. HoLRBT can be used as an alternative procedure for TURBT in terms of low-grade papillary urothelial carcinoma or low-grade early TNM-stage urothelial carcinoma.

A New Method of Establishing Orthotopic Bladder Transplantable Tumor in Mice

Objective The present study aims to find a convenient, rapid, and stable method to establish bladder tumor in mice. Methods Female Balb/C-nu-nu nude mice （or female T739 mice） were narcotized by sodium pentobarbital at a dosage of 60 mg/ kg. The stylet of the 24# venous retention needles was bent in a 5° to 7° angle at a distance of 15 mm from the needlepoint to form a circle with 2.61 mm to 3.66 mm radius when the stylet is rotated. The pipe casing was lubricated with liquid paraffin, and inserted into the bladder cavity. The drift angle stylet was inserted into the pipe casing slowly, rotated for five times, and then pulled out. A cell 6 suspension （0.1 mL） of approximately lx10 T24 cells （or BTT cells） was then injected imme＆ately. Results A total of 60 T739 mice and 60 Balb/C-nu-nu nude mice were inoculated with BTT cells and T24 cells, respectively. The bladder tumor incidence and the average survival time of the tumor-bearing mice were 100% and （26.69±9.24） d and 100% and （34.59±9.8） d for the T739 mice and Balb/C-nu-nu nude mice, respectively. Conclusions Using the drift angle stylet to injure the mucous membrane of the urinary bladder can establish a stable bladder transplantable tumor model in mice.

Treatment and surveillance for non-muscle-invasive bladder cancer:a clinical practice guideline(2021 edition)

Non-muscle invasive bladder cancer(NMIBC)is a major type of bladder cancer with a high incidence worldwide,resulting in a great disease burden.Treatment and surveillance are the most important part of NIMBC management.In 2018,we issued“Treatment and surveillance for non-muscle-invasive bladder cancer in China:an evidencebased clinical practice guideline”.Since then,various studies on the treatment and surveillance of NMIBC have been published.There is a need to incorporate these materials and also to take into account the relatively limited medical resources in primary medical institutions in China.Developing a version of guideline which takes these two issues into account to promote the management of NMIBC is therefore indicated.We formed a working group of clinical experts and methodologists.Through questionnaire investigation of clinicians including primary medical institutions,24 clinically concerned issues,involving transurethral resection of bladder tumor(TURBT),intravesical chemotherapy and intravesical immunotherapy of NMIBC,and follow-up and surveillance of the NMIBC patients,were determined for this guideline.Researches and recommendations on the management of NMIBC in databases,guideline development professional societies and monographs were referred to,and the European Association of Urology was used to assess the certainty of generated recommendations.Finally,we issued 29 statements,among which 22 were strong recommendations,and 7 were weak recommendations.These recommendations cover the topics of TURBT,postoperative chemotherapy after TURBT,Bacillus Calmette–Guérin(BCG)immunotherapy after TURBT,combination treatment of BCG and chemotherapy after TURBT,treatment of carcinoma in situ,radical cystectomy,treatment of NMIBC recurrence,and follow-up and surveillance.We hope these recommendations can help promote the treatment and surveillance of NMIBC in China,especially for the primary medical institutions.

Treatment trends of muscle invasive bladder cancer: Evidence from the Surveillance, Epidemiology, and End Results database, 1988 to 2013

Objective:Guidelines for muscle-invasive bladder cancer(MIBC)recommend that patients receive neoadjuvant chemotherapy with radical cystectomy as treatment over radical cystectomy alone.Though trends and practice patterns of MIBC have been defined using the National Cancer Database,data using the Surveillance,Epidemiology,and End Results(SEER)program have been poorly described.Methods:Using the SEER database,we collected data of MIBC according to the American Joint Commission on Cancer.We considered differences in patient demographics and tumor charac-teristics based on three treatment groups:chemotherapy(both adjuvant and neoadjuvant)with radical cystectomy,radical cystectomy,and chemoradiotherapy.Multinomial logistic regression was performed to compare likelihood ratios.Temporal trends were included for each treatment group.Kaplan-Meier curves were performed to compare cause-specific sur-vival.A Cox proportional-hazards model was utilized to describe predictors of survival.Results:Of 16728 patients,10468 patients received radical cystectomy alone,3236 received chemotherapy with radical cystectomy,and 3024 received chemoradiotherapy.Patients who received chemoradiotherapy over radical cystectomy were older and more likely to be African American;stage III patients tended to be divorced.Patients who received chemotherapy with radical cystectomy tended to be males;stage II patients were less likely to be Asian than Caucasian.Stage III patients were less likely to receive chemoradiotherapy as a treatment op-tion than stage II.Chemotherapy with radical cystectomy and chemoradiotherapy are both un-derutilized treatment options,though increasingly utilized.Kaplan-Meier survival curves showed significant differences between stage II and III tumors at each interval.A Cox proportional-hazards model showed differences in gender,tumor stage,treatment modality,age,andmarital status.Conclusion:Radical cystectomy alone is still the most commonly used treatment for muscle-invasive bladder cancer based on temporal trends.Significant disparities exist in those who receive radical cystectomy over chemoradiotherapy for treatment.