Effect of neoadjuvant chemotherapy on years of life lost in radical cystectomy-treated T2N0M0 bladder cancer patients

Introduction: Neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) is standard of care for T2N0M0 urothelial carcinoma of urinary bladder (UCUB) patients. However, the effect of NAC on years of life lost (YLL) in RC-treated T2N0M0 patients has never been quantified. Methods: Within the Surveillance, Epidemiology, and End Results (SEER) database (2004–2021), T2N0M0 UCUB patients aged 40–75 years treated with RC, with or without NAC, were included. Relying on Social Security Administration (SSA) life tables, an age/sex-matched control (Monte Carlo simulation) was simulated for each patient. Kaplan-Meier method was used to calculate average YLL until the age of 75 years between SEER cases and SSA simulated controls. Results: Overall, 1511 (27.8%) T2N0M0 UCUB patients treated with RC + NAC and 3932 (72.2%) with RC alone were identified. Compared to simulated population controls, RC + NAC vs. RC alone patients exhibited 1.3 vs. 2.3 YLL. In sensitivity analyses according to age at diagnosis, the most pronounced YLL values were recorded in youngest patients (40–55 years): RC + NAC: 2.2 YLL vs. RC alone: 6.1 YLL. Intermediate YLL values were recorded in intermediate age patients (56–65 years): RC + NAC: 1.9 YLL vs. RC alone: 3.2 YLL. Finally, the least pronounced YLL values were recorded in oldest patients (66–75 years): RC + NAC: 0.4 YLL vs. RC alone: 0.7 YLL. Invariably, RC alone was associated with higher YLL values than RC + NAC. Conclusion: When YLL represented the endpoint, RC + NAC patients exhibited more favorable outcomes than RC alone patients. In both RC + NAC and RC alone groups maximal YLL applied to youngest individuals and decreased in proportion to increasing age.