Neoadjuvant cisplatin-based chemotherapy (NAC) has been shown to improve overall survival for patients with muscle-invasive urothelial bladder cancer (MIBC) [1]. However, there is a lack of evidence of the benefit of NAC for patients with variant histology (VH). A large recent retrospective study of patients in the National Cancer Database found that NAC was associated with improved overall survival (OS) for patients with sarcomatoid or neuroendocrine variants of urothelial carcinoma, but not for micropapillary, squamous, or adenocarcinoma subtypes [2]. Another retrospective analysis found that NAC was associated with lower odds of extravesical disease among patients with VH but only showed a survival benefit for patients with neuroendocrine tumors [3].

The International Robotic Cystectomy Consortium (IRCC) comprises 4,073 patients from 31 institutions across 11 countries. The IRCC has a robust pooled dataset as well as long-term follow-up for patients undergoing robot-assisted radical cystectomy (RARC) [4]. Our goal was to describe the utilization of NAC, report the frequency of pathologic downstaging, and survival outcomes among patients who underwent RARC for MIBC with VH using this multi-institutional dataset.