Does Neoadjuvant Chemotherapy Followed by Radical Cystectomy Improve the Survival of Muscle-Invasive Bladder Cancer in Real-World Clinical Practice?

OBJECTIVES

Due to unclear evidence of survival improvement, this study aimed to evaluate the efficacy of neoadjuvant chemotherapy for muscle-invasive bladder cancer in real-world clinical practice in Japan.

METHODS

We initially extracted patients who underwent open radical cystectomy between July 2000 and May 2021 at Kanazawa University Hospital from the medical charts, and we selected patients diagnosed with pure urothelial carcinoma. Progression-free survival and cancer-specific survival were compared based on the presence or absence of neoadjuvant chemotherapy. We also examined prognostic factors related to cancer-specific survival.

RESULTS

Of 107 patients who underwent open radical cystectomy, 91 with pure urothelial carcinoma were analyzed. Progression-free survival and cancer-specific survival were significantly different between the presence and absence of neoadjuvant chemotherapy (median progression-free survival: not reached vs. 21.4 months, p = 0.0167, and median cancer-specific survival: not reached vs. 66.6 months, p = 0.0017, respectively). Multivariate analysis revealed five independent poor prognostic factors: age ≥ 70 years, pN+, ≥ pT2, high neutrophil-to-lymphocyte ratio, and high C-reactive protein level. Based on the number of independent poor prognostic factors, the patients were divided into three risk groups that showed significantly different cancer-specific survival (p < 0.0001).

CONCLUSIONS

Neoadjuvant chemotherapy improved the prognosis of patients with muscle-invasive bladder cancer treated with open radical cystectomy in real-world clinical practice.