Bladder cancer (BCa) is the sixth most prevalent cancer in the US. While metastatic BCa (mBCa) represents only 5% of new BCa diagnoses, it is notably aggressive, leading to poor patient prognosis. Currently, multiagent chemotherapy remains as the endorsed first-line treatment for eligible patients with mBCa [1]. Studies have demonstrated the efficacy of cytoreductive organ resection in metastatic renal cell carcinoma and potentially metastatic prostate cancer [2], [3], [4]. However, the potential benefits of cytoreductive radical cystectomy (CRC) in mBCa is unclear. Historically, the associated morbidity of cystectomy has been a barrier to performing CRC without curative intent [5]. Nevertheless, recent research has revealed that high-intensity local treatment—integrating multiagent chemotherapy with CRC or targeted radiation exceeding 50 Gy—could extend median overall survival (OS) by 5 months compared to limited treatment—defined as multiagent chemotherapy alone or in conjunction with transurethral resection of the bladder tumor (TURBT) or targeted radiation below 50 Gy [6].

The selective application of CRC, given its significant and permanent impact on quality of life, necessitates the identification of patient and/or tumor predictors of favorable response. It has been demonstrated that mBCa patients may experience survival benefit with high-intensity local treatment irrespective of their baseline mortality risk, suggesting that patient mortality risk may not be ideal as a CRC selection criteria [7]. Alternatively, metastatic site and quantity have been proposed to be significant prognostic indicators in mBCa [8], [9], [10]. Our study seeks to evaluate the oncologic efficacy of CRC, emphasizing metastatic site and number as predictors of treatment response.