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Use of treatment pathway improves neoadjuvant chemotherapy use in muscle-invasive bladder cancer

  • Urology - Original Paper
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Abstract

Purpose

To assess the trends of neoadjuvant chemotherapy (NAC) use since its introduction in our practice pathway in patients with cT2 + bladder cancer over a 20-year period.

Methods

This is a retrospective review of patients with cT2 + bladder cancer who underwent RC between 01/01/1998 and 01/01/2018 that aimed to evaluate the trends of NAC use and associated after implementation of a multidisciplinary treatment pathway. Cohorts were stratified into eras: pre-NAC (1998–2007) to NAC eras (2008–2018). Univariate analysis was conducted using Chi-squared test and Kaplan–Meier estimates were used to evaluate survival.

Results

In 904 total patients who underwent RC, there were 493 with cT2 + UCC disease. The rate of NAC peaked at 84.2% in the most recent year of analysis in all patients and was 100% in cT2 + patients eligible for NAC. There was an increased rate of complete response (downstage to pT0) from 8.7% to 15.8% (p = 0.018) between the two eras. Unadjusted survival analysis revealed improved overall survival (OS) between eras with 5-year OS 53.2% vs. 42.7% and 10-year OS 42.7% vs. 26.4% in the NAC vs. pre-NAC cohorts, respectively (p = 0.016).

Conclusions

In this review of 20 years of experience, we report a dramatic rise in the use of NAC after adoption of a multidisciplinary pathway that is associated with expected survival benefits.

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Authors and Affiliations

  1. Department of Urology, Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA

    Kassem S. Faraj, Anojan K. Navaratnam, Laila Elias, Amit Syal, Mark D. Tyson & Erik P. Castle

  2. Creighton University, Omaha, NE, USA

    Sarah Eversman

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  1. Kassem S. Faraj
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  2. Anojan K. Navaratnam
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  3. Sarah Eversman
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Correspondence to Kassem S. Faraj.

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Faraj, K.S., Navaratnam, A.K., Eversman, S. et al. Use of treatment pathway improves neoadjuvant chemotherapy use in muscle-invasive bladder cancer. Int Urol Nephrol 53, 1111–1118 (2021). https://doi.org/10.1007/s11255-020-02752-z

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  • DOI: https://doi.org/10.1007/s11255-020-02752-z

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