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

Purpose: 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. Materials and Methods: 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. Results: 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). Conclusions: 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.