Improving Urothelial Carcinoma Outcomes: The Powerful Combination of Neoadjuvant and Adjuvant Chemotherapy in the Perioperative Period.

INTRODUCTION

To enhance urothelial carcinoma (UC) prognosis, clinicians combine surgery with intraoperative (ICT), neoadjuvant (NACT), or adjuvant chemotherapy (ACT); however, studies on their individual and combined effects vary. Furthermore, studies on the combined use of ACT and NACT are scarce.

OBJECTIVE

This study aimed to assess the impact of these chemotherapy regimens on UC prognosis, particularly the effectiveness of ACT + NACT, using the Surveillance, Epidemiology, and End Results (SEER) database.

METHODS

We analyzed 45,211 UC cases from 2019 to 2021, focusing on renal, ureter, bladder, prostate, and urethra UC. Cox model-adjusted survival curves and multivariable Cox regression were performed using SPSS and R software.

RESULTS

Compared with ACT, NACT alone did not significantly impact survival (hazard ratio [HR] 0.834, 95% confidence interval [CI] 0.392-1.774, p = 0.638), whereas ACT + NACT (HR 0.389, 95% CI 0.169-0.895, p = 0.026) and ICT + ACT + NACT (HR 0.466, 95% CI 0.246-0.883, p = 0.019) positively affected UC prognosis. However, when compared with the combination of ACT + NACT, the combination of ICT + ACT + NACT did not show a statistically significant effect (HR 1.198, 95% CI 0.427-3.362, p = 0.731). Compared with no chemotherapy, ACT reduced renal UC survival (HR 1.430, 95% CI 1.105-1.850, p = 0.007) but improved ureter (HR 0.460, 95% CI 0.232-0.915, p = 0.027) and bladder UC survival (HR 0.605, 95% CI 0.466-0.785, p < 0.001).

CONCLUSIONS

Prognosis after chemotherapy varied depending on different tumor locations. ACT reduced the prognosis of renal UC patients but elevated the prognosis of ureter UC and bladder UC patients. Distinct chemotherapy protocols have also yielded varying prognostic outcomes. For UC patients, the combination of ACT + NACT merits consideration in order to achieve better prognostic outcomes than the use of ACT or NACT alone. The adoption of ICT for UC patients may not be necessary.