Background Cisplatin-based neoadjuvant chemotherapy (NAC) is the standard of care for cT2-4aN0M0 bladder cancer (BCa) patients candidates for radical cystectomy (RC). This study examines changes in NAC administration over time and its impact on survival within a large, real-world multicenter cohort. Methods Our analysis included cT2-4aN0M0 BCa patients from 23 tertiary referral centers who underwent RC and pelvic lymph-node dissection with or without NAC administration between 2004 and 2024. The estimated annual percentage change (EAPC) was used to analyze the temporal trend of NAC administration and pathological complete response rates (pT0) over time. Subsequently, we relied on 1:1 propensity score matching (PSM) for age, sex, cT stage, Charlson Comorbidity Index (CCI), and smoking habit. Multivariable logistic regression (MLR) model addressed the association of pT0 and NAC exposure. Survival analyses consisted of Kaplan-Meier plots (KM) and multivariable Cox regression models (MCR) addressing cancer-specific mortality (CSM) and overall mortality (OM) according to NAC exposure. Results Overall, 3,138 patients were identified. Of these, 859 (27%) received NAC. NAC implementation increased substantially from 2004 to 2024 (EAPC: + 9.2%, p < 0.001), as well as pT0 rates (EAPC: + 7.6, p < 0.001). After 1:1 PSM (847 NAC + vs. 847 NAC-), MLR showed NAC as the strongest predictor of pT0 (OR: 2.89, p < 0.001). KM estimated 5-year CSM and OM rates of 22.5% versus 31.3% and 23.6 versus 34.5% in NAC + versus NAC-, respectively.At MCR, NAC exposure was associated with lower CSM (HR: 0.90, p = 0.01) and OM (HR:0.85, p = 0.001) rates relative to their unexposed counterparts. Conclusions The current study demonstrated a significant increase in NAC administration over time, accompanied by higher rates of pT0 as well as improved survival among NAC-treated patients. The major limitation is represented by the retrospective nature of the study.
Real-world impact of cisplatin-based neoadjuvant chemotherapy on bladder cancer survival: a 20-year study
Antonelli, Alessandro;Bertolo, Riccardo;
2025-01-01
Abstract
Background Cisplatin-based neoadjuvant chemotherapy (NAC) is the standard of care for cT2-4aN0M0 bladder cancer (BCa) patients candidates for radical cystectomy (RC). This study examines changes in NAC administration over time and its impact on survival within a large, real-world multicenter cohort. Methods Our analysis included cT2-4aN0M0 BCa patients from 23 tertiary referral centers who underwent RC and pelvic lymph-node dissection with or without NAC administration between 2004 and 2024. The estimated annual percentage change (EAPC) was used to analyze the temporal trend of NAC administration and pathological complete response rates (pT0) over time. Subsequently, we relied on 1:1 propensity score matching (PSM) for age, sex, cT stage, Charlson Comorbidity Index (CCI), and smoking habit. Multivariable logistic regression (MLR) model addressed the association of pT0 and NAC exposure. Survival analyses consisted of Kaplan-Meier plots (KM) and multivariable Cox regression models (MCR) addressing cancer-specific mortality (CSM) and overall mortality (OM) according to NAC exposure. Results Overall, 3,138 patients were identified. Of these, 859 (27%) received NAC. NAC implementation increased substantially from 2004 to 2024 (EAPC: + 9.2%, p < 0.001), as well as pT0 rates (EAPC: + 7.6, p < 0.001). After 1:1 PSM (847 NAC + vs. 847 NAC-), MLR showed NAC as the strongest predictor of pT0 (OR: 2.89, p < 0.001). KM estimated 5-year CSM and OM rates of 22.5% versus 31.3% and 23.6 versus 34.5% in NAC + versus NAC-, respectively.At MCR, NAC exposure was associated with lower CSM (HR: 0.90, p = 0.01) and OM (HR:0.85, p = 0.001) rates relative to their unexposed counterparts. Conclusions The current study demonstrated a significant increase in NAC administration over time, accompanied by higher rates of pT0 as well as improved survival among NAC-treated patients. The major limitation is represented by the retrospective nature of the study.
I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
