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Published on: October 30, 2013
Time to Treatment Initiation and Survival in Patients With Muscle-Invasive Bladder Cancer (MIBC)
Andrea Piccolini1, Marco Paciotti2, Stephan M Korn3
1Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
Timely treatment initiation is crucial for muscle-invasive bladder cancer (MIBC) survival. Neoadjuvant chemotherapy (NAC) within 60 days improves outcomes, but delays beyond this timeframe do not offer additional survival benefits.
Area of Science:
- Oncology
- Urothelial Carcinomas
- Bladder Cancer Research
Background:
- Muscle-invasive bladder cancer (MIBC) requires prompt treatment for optimal outcomes.
- Cisplatin-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) is standard, but real-world adherence is inconsistent.
- Evaluating the impact of time-to-treatment initiation (TTI) on overall survival (OS) in MIBC is critical.
Purpose of the Study:
- To assess the association between TTI and OS in patients with MIBC.
- To determine the survival impact of different treatment initiation timelines for NAC and RC.
Main Methods:
- Analysis of the National Cancer Database (2004-2022) for patients with cT2-T4aN0M0 urothelial MIBC treated with RC +/- NAC.
- Stratification into four groups based on timing of RC and NAC initiation (within or beyond 60 days).
- Application of inverse probability of treatment weighting (IPTW) and adjusted Cox models to estimate OS.
Main Results:
- In cT2N0M0 disease, NAC within 60 days significantly improved OS compared to upfront RC within 60 days (HR:0.79).
- Delayed NAC (>60 days) showed no significant OS benefit in cT2N0M0 disease (HR:0.83).
- In cT3-T4aN0M0 disease, delayed RC (>60 days) was associated with worse OS (HR:1.21), while early NAC improved survival (HR:0.78).
Conclusions:
- Time-to-treatment initiation is a significant determinant of survival in MIBC.
- NAC initiated within 60 days of diagnosis maintains its survival advantage.
- Streamlined care pathways and timely multidisciplinary coordination are essential for improving MIBC patient outcomes.