Introduction

Neoadjuvant chemotherapy is considered the standard of care in patients with muscle-invasive bladder cancer (MIBC) and has been shown to confer overall survival advantages of 5% in RCTs. Data on neoadjuvant chemotherapy (NAC) administration rates in patients undergoing robot-assisted radical cystectomy (RARC) is limited, ranging from 0 to 31% in the published literature. We report administration rates of NAC from a multi-institutional European database focusing on the centres performing totally intracorporeal RARC. Reporting the effect of NAC on down-staging and up-staging rates from clinical staging (cT) to the pathological specimen (pT).

Methods

Retrospective review of the prospectively populated multi-institutional database identified 717 patients at 9 different Institutions (6 countries), with a minimum of 12 months follow-up, who underwent RARC for non-metastatic bladder cancer with curative intent between Dec 2003 and March 2015. Clinical stage was assigned based on a combination of specimen pathology from TURBT, EUA and imaging studies. Cisplatin based NAC was offered to patients with cT2-cT4, taking into account patient performance status. Clinical staging, pathologic staging and survival data at the latest follow-up were collected.

Results

Median age was 68 years, 78% were men. 95.2% of patients had TCC. 532 (74.2%) patients were alive at the time of the analysis. The median follow-up time for patients was 31 months (IQR 20-46). 465 patients (65%) had cT2-T4 TCC. In this series 25.3% of patients received NAC. See table 1 for upstaging and down-staging related to NAC. PSM rates were associated with upstaging (p<0.001). On multivariable analysis NAC was associated with down-staging in all patients OR 3.46 95% CI 2.34-5.13 p <0.001 and this effect increased in patients with non-organ confined disease OR 5.45 95%CI 2.15-13.8 p<0.001. The 5-year CSS, OS and RFS were 69.9%, 66.1% and 66.3% respectively. On multivariable analysis, pathological non-organ confined versus organ confined disease was found to impact CSS, OS and RFS (HR 4.4, 3.8 and 3.8 respectively).

Conclusions

NAC was associated with downstaging of MIBC. Increasing NAC administration rates would likely further improve oncological outcomes.

Funding

None