Neoadjuvant chemotherapy (NAC) plus radical cystectomy (RC) may lead to superior complete pathological downstaging (pCD) and overall survival (OS) among patients with bladder cancer, according to a study published in the International Journal of Cancer.1

For this large population-based study, researchers assessed the outcomes of 5517 patients with cT2 to 4aN0M0 urothelial carcinoma (UC) of the bladder who underwent RC alone, NAC plus RC, or NAR plus RC. Of the evaluated patients, 4504 (82%) of patients had cT2 disease and 1013 (18%) had cT3 to cT4a disease. For this study, pCD was defined as downstaging to nonmuscle invasive disease without lymph node metastases.

After a median follow-up of 9.2 years, the pCD rate was 25% after RC alone compared with 43% after NAC plus RC (P < .001) and 33% after NAR plus RC (P =.13) among patients with cT2 UC. Among patients with cT3 to cT4a UC, pCD-rate was 8% after RC alone compared with 37% (P < .001) and 16% (P = .281) after NAC plus RC and NAR plus RC, respectively.

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The 5-year OS rate was 57% and 51% for NAC plus RC compared with RC alone, respectively (P = .135) among patients with cT2 UC. Benefits from NAC plus RC were more pronounced among patients with advanced disease; in patients with cT3 to cT4a UC, the 5-year OS was 55% and 36%, respectively (P < .001).

A multivariable analysis showed that NAC conferred an OS benefit in cT3 to cT4a disease (hazard ratio [HR], 0.67; 95% CI, 0.51-0.89) but not among patients with cT2 UC (HR, 0.91; 95% CI, 0.72-1.15); NAR was not found to influence OS.

The authors concluded that the “results contribute to the debate to consider a more tailored use of perioperative chemotherapy, whereby usage of NAC is strongly recommended in locally advanced cT3-4aN0M0 urothelial BC.”


  1. Hermans TJN, Voskuilen CS, Deelen M, et al. Superior efficacy of neoadjuvant chemotherapy and radical cystectomy in cT3-4aN0M0 compared to cT2N0M0 bladder cancer [published online August 28, 2018]. Int J Cancer. doi: 10.1002/ijc.31833