Impact of neoadjuvant chemotherapy on short-term complications and survival following radical cystectomy
To compare perioperative and short-term postoperative complication rates between patients receiving radical cystectomy (RC) after neoadjuvant chemotherapy (NAC) and patients undergoing RC alone. Secondary objectives were to compare overall survival (OS) and cancer-specific survival (CSS).
Materials and methods
Clinico-pathological data of all patients who received RC between 1996 and 2015 were retrospectively collected. Only patients with RC for muscle-invasive bladder cancer were included in the final analysis. Short-term (30-day) postoperative complications were assessed by registering the Clavien–Dindo classification (CDC) and dividing into sub-groups: low-grade (LGC) CDC 1–2 and high-grade (HGC) CDC 3–5. To compare populations with similar age, comorbidities and preoperative creatinine, we used a propensity score-adjusted statistical model. Pre- and perioperative predictors of short-term complications were identified using uni- and multivariable models. Survival was assessed using Kaplan–Meier analysis.
A total of 491 patients undergoing RC were included, of whom 102 (20.8%) received NAC. After propensity score covariate adjustment, there was no significant difference in postoperative complications between patients undergoing NAC plus RC and RC alone with an overall complication rate of 69% and 66%, respectively. No significant differences in the 30-day HGC rates (11.76% and 11.83%, respectively) were observed. NAC plus RC patients had worse prognostic factors at baseline; nevertheless, after correction for group differences OS and CSS did not differ from RC only group (5-year OS 61.3% vs. 50.2%, and 5-year CSS 61.8% vs. 57.9% respectively, p > 0.05 for all).
In appropriately selected patients, exposure to NAC is not associated with increased short-term complications.
KeywordsRadical cystectomy Bladder cancer Neoadjuvant chemotherapy Complications Short term
Non-muscle-invasive bladder cancer
Muscle-invasive bladder cancer
Pelvic lymph node dissection
Carcinoma in situ
Charlson comorbidity index
Age-adjusted Charlson comorbidity index
Body mass index
Estimated blood loss
Length of stay
Cumulative incidence function
Inverse probability of treatment weighting
Urinary tract infection
Akand M is supported by a clinical scholarship from the European Urologic Scholarship Program (EUSP).Joniau S is a senior clinical researcher of the research foundation of Flanders (FWO).
UM: Data collection, data analysis, manuscript writing. MA: Data analysis, manuscript writing, manuscript editing. LM: Data collection, data analysis. LD: Data collection, data analysis. TM: Data analysis, manuscript editing. YB: Data collection, data analysis. AL: Data analysis, manuscript editing. BVC: Data collection, data analysis. WE: Data collection, data analysis. HVP: Project development, data analysis, manuscript editing. HD: Project development, data analysis, manuscript editing. MA: Project development, data analysis, manuscript editing. SJ: Project development, data analysis, manuscript editing.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest related to this manuscript.
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.
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