The effect of neoadjuvant chemotherapy on perioperative outcomes in patients who have bladder cancer treated with radical cystectomy: a population-based study.
BACKGROUND
Although therapeutic guidelines recommend the use of neoadjuvant chemotherapy before radical cystectomy (RC) in patients who have muscle-invasive bladder cancer (MIBC), this approach remains largely underused. One of the main reasons for this phenomenon might reside in concerns regarding the risk of morbidity and mortality associated with neoadjuvant chemotherapy.


OBJECTIVE
To compare perioperative outcomes between patients receiving neoadjuvant chemotherapy and those treated with RC alone.


METHODS
Relying on the Surveillance Epidemiology and End Results-Medicare-linked database, 3760 patients diagnosed with MIBC between 2000 and 2009 were evaluated.


METHODS
RC alone or RC plus neoadjuvant chemotherapy.


METHODS
Complications occurred within 30 and 90 d after surgery. Heterologous blood transfusions (HBTs), length of stay (LoS), readmission, and perioperative mortality were compared. To decrease the effect of unmeasured confounders associated with treatment selection, propensity score-matched analyses were performed.


CONCLUSIONS
Overall, 416 (11.1%) of patients received neoadjuvant chemotherapy. Following propensity score matching, 416 (20%) and 1664 (80%) patients treated with RC plus neoadjuvant chemotherapy and RC alone remained, respectively. The 30-d complication, readmission, and mortality rates were 66.0%, 32.2%, and 5.3%, respectively. The 90-d complication, readmission, and mortality rates were 72.5%, 46.6%, and 8.2%, respectively. When patients were stratified according to neoadjuvant chemotherapy status, no significant differences were observed in the rates of complications, HBT, prolonged LoS, readmission, and mortality between the two groups (all p ≥ 0.1). These results were confirmed in multivariate analyses, where the use of neoadjuvant chemotherapy was not associated with higher risk of 30- and 90-d complications, HBT, prolonged LoS, readmission, and mortality (all p ≥ 0.1). Our study is limited by its retrospective nature.


CONCLUSIONS
The use of neoadjuvant chemotherapy is not associated with higher perioperative morbidity or mortality. These results should encourage wider use of neoadjuvant chemotherapy when clinically indicated.


RESULTS
Chemotherapy before radical cystectomy in patients with muscle-invasive bladder cancer does not increase the risk of complications or death. The use of chemotherapy should be strongly encouraged, as recommended by clinical guidelines, given its benefits.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec, Canada; Department of Urology, Vita-Salute San Raffaele University, Milan, Italy. Electronic address: giorgio.gandaglia@gmail.com.
Giorgio
G
Gandaglia
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec, Canada; Department of Urology, University of Montreal Health Centre, Montreal, Quebec, Canada.
Ioana
I
Popa
Department of Urology, Vita-Salute San Raffaele University, Milan, Italy.
Firas
F
Abdollah
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec, Canada; Martini-clinic, Prostate Cancer Centre Hamburg-Eppendorf, Hamburg, Germany.
Jonas
J
Schiffmann
Department of Urology, Medical University of Vienna, Vienna, Austria.
Shahrokh F
SF
Shariat
Department of Urology, Vita-Salute San Raffaele University, Milan, Italy.
Alberto
A
Briganti
Department of Urology, Vita-Salute San Raffaele University, Milan, Italy.
Francesco
F
Montorsi
Division of Urologic Surgery, Department of Surgical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
Quoc-Dien
QD
Trinh
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec, Canada; Department of Urology, University of Montreal Health Centre, Montreal, Quebec, Canada.
Pierre I
PI
Karakiewicz
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec, Canada.
Maxine
M
Sun
D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D017024:Chemotherapy, Adjuvant; D015653:Cystectomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D020360:Neoadjuvant Therapy; D010359:Patient Readmission; D059035:Perioperative Period; D057216:Propensity Score; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*
Complications; Muscle-invasive bladder cancer; Neoadjuvant chemotherapy; Radical cystectomy