374 Background: Neoadjuvant chemotherapy for patients with muscle-invasive bladder cancer (MIBC) has better survival benefit than radical cystectomy (RC) alone. However, recurrences still occur in many cases and recurrent disease is the most lethal factor associated with death in MIBC. On the other hand, the rate and pattern of recurrences after neoadjuvant chemotherapy in MIBC patients remains unclear. Methods: Eligible patients had histologically confirmed stage T2-T4a muscle-invasive urothelial carcinoma of the bladder without lymph node or distant metastasis in this study. The cohort of neoadjuvant group consists of 130 patients with MIBC. The cohort of RC alone group includes 135 patients with MIBC treated with RC and bilateral pelvic lymph node dissection between May 1994 and July 2007. Propensity score matching was used to adjust for potential selection biases associated with treatment type. Recurrence site was defined as local, LN (lymph nodes), and distant metastases. Results: Propensity score-matched analysis indicated 130 matched pairs from both groups. The 5-year overall survival rate was 91% for neoadjuvant GCarbo versus 49% for RC alone group (P < 0.0001). The disease-free survival rate was 87% for neoadjuvant GCarbo versus 57% for surgery alone (P < 0.0001). The distant metastases were comparable in both groups. The total number of local recurrences or LN mets was markedly decreased in neoadjuvant GCarbo compared with RC alone cohort. Conclusions: The MIBC patients treated with neoadjuvant GCarbo achieved an improved oncological outcome with a different recurrence pattern compared to RC alone.
Efficient delivery of radical cystectomy after neoadjuvant chemotherapy for muscle-invasive bladder cancer
