Studies on the effect of a delay in RC after NAC are sparse.

Current studies rarely adjust for waiting times that occur before the last cycle of NAC.

Longer time to RC following NAC is associated with worse overall survival.

Longer time to RC following NAC is associated with a higher risk of pN+ at RC.

Current muscle-invasive bladder cancer (MIBC) guidelines recommend not delaying radical cystectomy (RC) >3 months after diagnosis as it decreases overall survival (OS). However, literature investigating the impact of delay in RC in patients who receive NAC is limited, especially on a population-based level.

To investigate the association between time from diagnosis of MIBC to RC (TTRC) in patients with urothelial bladder cancer (UBC) treated with NAC and RC and 1) 2-year OS and 2) pathological lymph node status (pN+) in a population-based cohort.

Patients were selected from the Netherlands Cancer Registry. The study included 237 patients with cT2-T4aN0M0 UBC, treated with NAC and RC between November 2017 and October 2019. Association between TTRC and OS was assessed using multivariable Cox regression analyses. Schoenfeld and Martingale residuals were used to investigate the proportional hazards assumption and whether a cut-off in the TTRC could be identified. Association between TTRC and pN+ was assessed using multivariable logistic regression analyses.

Median TTRC was 23 weeks (interquartile range (IQR) 19–26). 2-year OS was 67% (95%CI 59%–74%). Each week of delay in the TTRC was independently associated with 2-year OS (HR 1.06; P = 0.03) in the Cox regression analysis. The sensitivity analyses, defining TTRC as the time between last cycle of NAC and RC, revealed that each week of delay between NAC and RC was associated with 2-year OS (Hazard ratio (HR) 1.13; P < 0.0001), and with pN+ (Odds ratio (OR) 1.21; P = 0.01) in the Cox and logistic regression analyses, respectively.

A longer TTRC is associated with worse oncological outcomes in patients treated with NAC and RC.

Delay

Lymph node metastases

Neoadjuvant chemotherapy

Overall survival

Radical cystectomy

© 2024 The Author(s). Published by Elsevier Inc.