title: A Retrospective Analysis of the Effect on Survival of Time from Diagnosis to Neoadjuvant Chemotherapy to Cystectomy for Muscle Invasive Bladder Cancer.
abstract: OBJECTIVE
  We determine the impact of the timing of radical cystectomy from the diagnosis of muscle invasive bladder cancer on survival in patients also treated with neoadjuvant chemotherapy.
  
  
  METHODS
  We performed a retrospective chart review of consecutive patients with muscle invasive bladder cancer who received neoadjuvant chemotherapy followed by cystectomy between 1996 and 2014 at a single institution. Cox proportional hazards regression models were used to investigate the effect of treatment time intervals on overall survival. Three treatment intervals were analyzed for survival impact, from diagnosis of muscle invasive bladder cancer to initiation of neoadjuvant chemotherapy, from initiation of neoadjuvant chemotherapy to cystectomy and from diagnosis to cystectomy. Other pretreatment and posttreatment clinicopathological parameters were also analyzed.
  
  
  RESULTS
  Median time from the diagnosis of muscle invasive bladder cancer to radical cystectomy was 28 weeks. Cystectomy performed less than 28 weeks from the diagnosis did not result in significant improvement in overall survival outcomes (HR 0.68, 95% CI 0.28-1.63, p=0.388). Neither the timing of neoadjuvant chemotherapy initiation from diagnosis (median 6 weeks) nor the timing of cystectomy from neoadjuvant chemotherapy initiation (median 22 weeks) was associated with survival. Patient age, variant histology, extravesical and/or lymph node involvement (T3-4 and/or N1 or greater) were significantly associated with survival.
  
  
  CONCLUSIONS
  The timing of radical cystectomy in relation to muscle invasive bladder cancer diagnosis date does not significantly impact overall survival in patients with muscle invasive bladder cancer receiving neoadjuvant chemotherapy.
authors.affiliation: Department of Oncology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.
authors.forename: Jong Chul
authors.initials: JC
authors.lastname: Park
authors.affiliation: Department of Urology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.
authors.forename: Nilay M
authors.initials: NM
authors.lastname: Gandhi
authors.affiliation: Department of Oncology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland; Department of Urology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Carducci
authors.affiliation: Department of Oncology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland; Department of Urology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.
authors.forename: Mario A
authors.initials: MA
authors.lastname: Eisenberger
authors.affiliation: Department of Pathology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Baras
authors.affiliation: Department of Pathology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.
authors.forename: George J
authors.initials: GJ
authors.lastname: Netto
authors.affiliation: Department of Urology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.
authors.forename: Jen-Jane
authors.initials: JJ
authors.lastname: Liu
authors.affiliation: Department of Oncology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland; Department of Urology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland; Department of Immunology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.
authors.forename: Charles G
authors.initials: CG
authors.lastname: Drake
authors.affiliation: Department of Urology, Montefiore Medical Center and Albert Einstein College of Medicine, New York, New York.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Schoenberg
authors.affiliation: Department of Urology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.
authors.forename: Trinity J
authors.initials: TJ
authors.lastname: Bivalacqua
authors.affiliation: Department of Oncology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland; Department of Urology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland. Electronic address: nhahn4@jhmi.edu.
authors.forename: Noah M
authors.initials: NM
authors.lastname: Hahn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents
keywords: cystectomy; neoadjuvant therapy; time factors; urinary bladder neoplasms