Overview
Muscle-invasive bladder cancer has high recurrence risk even after curative surgery. Circulating tumor DNA (ctDNA), fragments of cancer DNA found in the bloodstream, may help identify patients at highest risk for recurrence. However, real-world evidence on how ctDNA predicts outcomes and informs treatment decisions is limited. This study evaluated real-world survival outcomes and treatment patterns by post-surgery ctDNA status among pts with MIBC or locally advanced bladder cancer and assessed prognostic value beyond pathologic response (pCR).
Researchers used Flatiron Health’s US Bladder Cancer Panoramic Database, inclusive of more than 43,000 patients with bladder cancer, to analyze data from 388 patients with MIBC or locally advanced bladder cancer who underwent surgery and ctDNA testing between 2015-2025. ctDNA testing increased dramatically over time, from 2.6% of patients in 2021 to 57% in 2025. Among patients with ctDNA results within 90 days after surgery, those testing positive for ctDNA had significantly worse 12-month overall survival (69% versus 97%) and disease-free survival (34% versus 73%) compared to those testing negative. ctDNA status further refined prognosis even when considering pathologic response to neoadjuvant therapy, particularly identifying high-risk patients among those who didn't achieve complete pathologic response.
Why this matters
These findings demonstrate that post-operative ctDNA testing has real prognostic value in bladder cancer, potentially identifying patients at highest risk for recurrence who may benefit from additional treatment strategies. As ctDNA testing becomes increasingly available, this research supports its use to complement traditional pathologic staging and inform personalized post-surgical management. Future work is needed to translate these findings into actionable treatment strategies that ultimately improve survival for patients with bladder cancer.