The effect of neoadjuvant chemotherapy on survival outcomes subsequent to radical cystectomy in pathological T0 bladder cancer patients: A multicenter large-scale analysis

• Published in: Investigative and clinical urology Vol. 66; no. 5; pp. 395 - 404
• Main Authors: Park, Jong Ho, Lee, Sangchul, Jeong, Seung-hwan, Ku, Ja Hyeon, Kim, Kyung Hwan, Nam, Jong Kil, Lim, Bumjin, Hong, Bum Sik, Nam, Wook, Kang, Sung Gu, Kang, Seok Ho, Kwon, Tae Gyun, Kim, Tae-Hwan, Heo, Jieun, Ham, Won Sik, Song, Geehyun, Seo, Ho Kyung, Song, Wan, Sung, Hyun Hwan, Jeong, Byong Chang, Oh, Jong Jin
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Urological Association 01.09.2025; 대한비뇨의학회
• Subjects: Aged; Chemotherapy, Adjuvant; cystectomy; Cystectomy - methods; Female; Humans; Male; Middle Aged; Neoadjuvant Therapy; Neoplasm Staging; Retrospective Studies; survival analysis; Survival Rate; Treatment Outcome; urinary bladder neoplasms; Urinary Bladder Neoplasms - drug therapy; Urinary Bladder Neoplasms - mortality; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - surgery; Urinary Bladder Neoplasms - therapy; 비뇨기과학; Neoadjuvant therapy; Survival analysis; Cystectomy; Urinary bladder neoplasms
• ISSN: 2466-0493; 2466-054X; 2466-054X
• DOI: 10.4111/icu.20250165

After radical cystectomy (RC), the pathologic complete response (pT0) among muscle-invasive bladder cancer (MIBC) is considered a favorable oncological result. The objective of this study was to evaluate the effect of neoadjuvant chemotherapy (NAC) among the pT0 patients using a large-scale multicenter study. This study included 3,972 patients who underwent RC at 11 tertiary medical centers. Analysis was conducted on patients with MIBC who achieved a pT0, with a focus on comparing results between those who received NAC and those who did not. Recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were analyzed in these groups. Among 252 eligible pT0 patients, 121 were categorized in the non-NAC group while the remaining 131 were in the NAC group. As compared to the non-NAC group, the NAC group demonstrated significantly better survival outcomes, with 5-year RFS rates of 89% vs. 80% (p=0.043), OS rates of 84% vs. 69% (p=0.011), and CSS rates of 95% vs. 80% (p=0.007). Multivariable Cox proportional hazards analyses demonstrated that NAC independently improved RFS (hazard ratio [HR] 0.192, p=0.002) and CSS (HR 0.200, p=0.020), but not OS (HR 0.672, p=0.263). In patients with MIBC who achieved a pT0, NAC administration prior to RC has a positive impact on oncological prognosis. Although further prospective studies are needed for validation, the results of this study will confirm the importance of NAC in MIBC.