Effects of neoadjuvant chemotherapy on pathological parameters and survival in patients undergoing radical cystectomy for muscle-invasive bladder cancer

Aim: To evaluate the effect of neoadjuvant chemotherapy on tumor pathology and patient survival in patients with muscle-invasive bladder cancer undergoing radical cystectomy. Neoadjuvant chemotherapy is believed to prevent micrometastasis and provide pathological downstaging. Materials and methods: Between June 2004 and March 2009, 74 patients with muscle-invasive bladder cancer were treated with radical cystectomy. Patients fit to receive chemotherapy were administered systemic chemotherapy of methotrexate, vinblastine, Adriamycin, and cisplatin (MVAC); gemcitabine and cisplatin (GC); or carboplatin and gemcitabine (CG). Patients in Group 1 (n = 36) did not receive any chemotherapy, while the remaining 38 patients in Group 2 did so, before radical cystectomy. Patient characteristics, pathological staging, and survival analysis were compared statistically between groups. Results: The mean follow-up time was 16.12 ± 12.13 months. There was no signifi cant diff erence between the groups regarding patient age, sex, preoperative clinical staging, lymph node invasion, comorbidity, type of urinary diversions done, postoperative early complications, progression-free survival (21.96 ± 3.5 and 23.44 ± 2.5 months; P = 0.275), and overall survival rates (25.76 ± 3.5 and 23.57 ± 2.4 months; P = 0.646). However, differences in pathological downstaging (pT3-pT4, 21.58% and 16.42% for groups 1 and 2, respectively; P 0.001) and perioperative mortality (6 vs. 0 deaths in groups 1 and 2; respectively) were significant between groups. Conclusion: Neoadjuvant chemotherapy may result in pathological downstaging while having no effects on progression- free or overall survival rates.