Perioperative Systemic Treatment Patterns and Postoperative Mortality Among Patients With Muscle-Invasive Bladder...

Area of Science:

• Urology
• Oncology
• Clinical Trials

Background:

• Muscle-invasive bladder cancer (MIBC) requires comprehensive treatment strategies.
• Radical cystectomy (RC) is a standard treatment for MIBC.
• Perioperative systemic therapy plays a crucial role in improving outcomes for MIBC patients.

Purpose of the Study:

• To analyze temporal trends in perioperative systemic treatment for stage II-III MIBC in Japan.
• To evaluate changes in neoadjuvant chemotherapy (NAC) and adjuvant therapy (AT) patterns.
• To assess the impact of these treatment shifts on postoperative mortality after RC.

Main Methods:

• Retrospective observational cohort study of 5,208 Japanese patients with stage II-III MIBC undergoing RC (2013-2024).
• Evaluation of treatment patterns: NAC+RC+AT, NAC+RC, RC+AT, and RC alone.
• Analysis of NAC regimen selection and 30/90-day postoperative mortality across three time periods (2013-2017, 2018-2021, 2022-2024).

Main Results:

• Increased use of NAC+RC (31.4% to 50.4%) and NAC+RC+AT (8.7% to 22.4%), with a decrease in RC alone (46.3% to 21.4%).
• Gemcitabine + cisplatin (GC) and gemcitabine + carboplatin remained common NAC regimens; adjuvant nivolumab use increased to 18.8% in 2022-2024.
• Postoperative mortality remained low (30-day: ≤0.2% with NAC vs. ≤1.5% without; 90-day: ≤1.4% with NAC vs. ≤3.3% without) despite intensified therapy.

Conclusions:

• Perioperative systemic therapy for MIBC in Japan has intensified over the last decade.
• Increased adoption of NAC and adjuvant nivolumab, alongside consistent use of modified GC and carboplatin regimens.
• Intensified treatment strategies have not led to increased postoperative mortality following RC.