- In patients with muscle-invasive bladder cancer (MIBC), neoadjuvant chemotherapy (NACT) delay of ≥8 weeks was associated with increased risk of upstaging.
- A delay for RC ≥6 months was not associated with worse OS in patients receiving NACT.
- The authors do not support skipping NACT to avoid RC delay, as long as RC is performed within 7 months from the initial diagnosis.
Why this matters
- Only 20% of patients receive NACT before RC, despite recommendations.
- 2227 patients with cT2-T4aN0M0 bladder cancer underwent NACT and RC during 2004-2014.
- Funding: None.
- Median follow-up, 45.7 months.
- Median times from diagnosis to NACT and RC were 39 and 155 days, respectively.
- NACT delay of ≥8 weeks was associated with increased risk of upstaging (OR, 1.27; P=.031).
- 41% of patients (including 22% with lymph nodes) were upstaged after RC.
- Significant predictors of treatment delay were:
- African-American race (OR, 2.10; P<.001>
- Medicaid or other government insurance (OR, 1.53; P=.046), and
- treatment at academic facilities (OR, 1.24; P=.047).
- Retrospective design.