TY - JOUR
T1 - Real-world impact of cisplatin-based neoadjuvant chemotherapy on bladder cancer survival: a 20-year study
AU - de Angelis, Mario
AU - Pellegrino, Francesco
AU - Scilipoti, Pietro
AU - Longoni, Mattia
AU - Santangelo, Alfonso
AU - Subiela, José Daniel
AU - Contieri, Roberto
AU - Afferi, Luca
AU - Zamboni, Stefania
AU - Suardi, Nazareno
AU - Musi, Gennaro
AU - Luzzago, Stefano
AU - D'Andrea, David
AU - Laukhtina, Ekaterina
AU - Soria, Francesco
AU - Gontero, Paolo
AU - Del Giudice, Francesco
AU - Khan, Muhammad Shamim
AU - Thurairaja, Ramesh
AU - Roupret, Morgan
AU - Grobet-Jeandin, Elisabeth
AU - Baudewyns, Arthur
AU - Tanaka, Hajime
AU - Matsumoto, Shunya
AU - Fujii, Yasuhisa
AU - Proietti, Flavia
AU - Simone, Giuseppe
AU - Schulz, Gerald Bastian
AU - Pyrgidis, Nicolaos
AU - Ploussard, Guillaume
AU - Antonelli, Alessandro
AU - Bertolo, Riccardo
AU - Roumiguie, Mathieu
AU - Bajeot, Anne-Sophie
AU - Mir, Maria Carme
AU - Umari, Paolo
AU - Teoh, Jeremy
AU - Wong, Chris
AU - Mertens, Laura S.
AU - Pichler, Renate
AU - Mori, Keiichiro
AU - Ślusarczyk, Aleksander
AU - Poyet, Cédric
AU - Albisinni, Simone
AU - Aziz, Atiqullah
AU - VOLPE, Alessandro
AU - Shariat, Shahrokh
AU - Pradere, Benjamin
AU - Karakiewicz, Pierre
AU - Resca, Stefano
AU - Beatrici, Edoardo
AU - De Groote, Ruben
AU - Mottrie, Alexandre
AU - Necchi, Andrea
AU - Montorsi, Francesco
AU - Briganti, Alberto
AU - Moschini, Marco
AU - null, null
PY - 2025
Y1 - 2025
N2 - Background: Cisplatin-based neoadjuvant chemotherapy (NAC) is the standard of care for cT2-4aN0M0 bladder cancer (BCa) patients candidates for radical cystectomy (RC). This study examines changes in NAC administration over time and its impact on survival within a large, real-world multicenter cohort. Methods: Our analysis included cT2-4aN0M0 BCa patients from 23 tertiary referral centers who underwent RC and pelvic lymph-node dissection with or without NAC administration between 2004 and 2024. The estimated annual percentage change (EAPC) was used to analyze the temporal trend of NAC administration and pathological complete response rates (pT0) over time. Subsequently, we relied on 1:1 propensity score matching (PSM) for age, sex, cT stage, Charlson Comorbidity Index (CCI), and smoking habit. Multivariable logistic regression (MLR) model addressed the association of pT0 and NAC exposure. Survival analyses consisted of Kaplan–Meier plots (KM) and multivariable Cox regression models (MCR) addressing cancer-specific mortality (CSM) and overall mortality (OM) according to NAC exposure. Results: Overall, 3,138 patients were identified. Of these, 859 (27%) received NAC. NAC implementation increased substantially from 2004 to 2024 (EAPC: + 9.2%, p < 0.001), as well as pT0 rates (EAPC: + 7.6, p < 0.001). After 1:1 PSM (847 NAC + vs. 847 NAC–), MLR showed NAC as the strongest predictor of pT0 (OR: 2.89, p < 0.001). KM estimated 5-year CSM and OM rates of 22.5% versus 31.3% and 23.6 versus 34.5% in NAC + versus NAC-, respectively.At MCR, NAC exposure was associated with lower CSM (HR: 0.90, p = 0.01) and OM (HR:0.85, p = 0.001) rates relative to their unexposed counterparts. Conclusions: The current study demonstrated a significant increase in NAC administration over time, accompanied by higher rates of pT0 as well as improved survival among NAC-treated patients. The major limitation is represented by the retrospective nature of the study.
AB - Background: Cisplatin-based neoadjuvant chemotherapy (NAC) is the standard of care for cT2-4aN0M0 bladder cancer (BCa) patients candidates for radical cystectomy (RC). This study examines changes in NAC administration over time and its impact on survival within a large, real-world multicenter cohort. Methods: Our analysis included cT2-4aN0M0 BCa patients from 23 tertiary referral centers who underwent RC and pelvic lymph-node dissection with or without NAC administration between 2004 and 2024. The estimated annual percentage change (EAPC) was used to analyze the temporal trend of NAC administration and pathological complete response rates (pT0) over time. Subsequently, we relied on 1:1 propensity score matching (PSM) for age, sex, cT stage, Charlson Comorbidity Index (CCI), and smoking habit. Multivariable logistic regression (MLR) model addressed the association of pT0 and NAC exposure. Survival analyses consisted of Kaplan–Meier plots (KM) and multivariable Cox regression models (MCR) addressing cancer-specific mortality (CSM) and overall mortality (OM) according to NAC exposure. Results: Overall, 3,138 patients were identified. Of these, 859 (27%) received NAC. NAC implementation increased substantially from 2004 to 2024 (EAPC: + 9.2%, p < 0.001), as well as pT0 rates (EAPC: + 7.6, p < 0.001). After 1:1 PSM (847 NAC + vs. 847 NAC–), MLR showed NAC as the strongest predictor of pT0 (OR: 2.89, p < 0.001). KM estimated 5-year CSM and OM rates of 22.5% versus 31.3% and 23.6 versus 34.5% in NAC + versus NAC-, respectively.At MCR, NAC exposure was associated with lower CSM (HR: 0.90, p = 0.01) and OM (HR:0.85, p = 0.001) rates relative to their unexposed counterparts. Conclusions: The current study demonstrated a significant increase in NAC administration over time, accompanied by higher rates of pT0 as well as improved survival among NAC-treated patients. The major limitation is represented by the retrospective nature of the study.
KW - Bladder cancer
KW - Cisplatin-based chemotherapy
KW - Multiinstitutional
KW - Neoadjuvant chemotherapy
KW - Radical cystectomy
KW - Bladder cancer
KW - Cisplatin-based chemotherapy
KW - Multiinstitutional
KW - Neoadjuvant chemotherapy
KW - Radical cystectomy
UR - https://iris.uniupo.it/handle/11579/223229
U2 - 10.1007/s00345-025-05992-9
DO - 10.1007/s00345-025-05992-9
M3 - Article
SN - 0724-4983
VL - 43
JO - World Journal of Urology
JF - World Journal of Urology
IS - 1
ER -
SDG 3 Salute e benessere