Neoadjuvant Versus Adjuvant Chemotherapy in Non-Metastatic Locally-Advanced Stage Radical Candidates

No study directly compared neoadjuvant (NAC) versus adjuvant chemotherapy (ADJ) T3-T4N0M0 urothelial carcinoma. Within the Surveillance, Epidemiology, and End Results database (20 07-2020), we identified 875 T3-T4N0M0 UCUB patients who underwent NAC + RC or RC + ADJ. Our result suggests that in T3-T4N0M0, NAC rates have sharply increased over time. However, the approach based on NAC + RC have not resulted in a statistically significant survival benefit relative to RC + ADJ. Introduction: Administration of chemotherapy before radical cystectomy (RC) in neoadjuvant setting (NAC) or after RC in adjuvant setting (ADJ) are both associated with a survival benefit relative to RC alone. However, no study directly compared the magnitude of such benefit associated with NAC versus ADJ in locally-advanced UCUB patients (T3-T4N0M0). We addressed this knowledge gap. Methods: Within the Surveillance, Epidemiology, and End Results database (2007-2020), we identified T3-T4N0M0 UCUB patients who underwent NAC + RC or RC + ADJ. Cumulative incidence plots and multivariable competing risks regression (CRR) models were fitted. The same methodology was then re-applied in T3 and then T4 patient subgroups. Results: Of 875 assessable patients, 603 harbored T3 stage (69.0%) and 272 harbored T4 stage (31.0%). Of all 875, 563 (64.0%) underwent RC + ADJ versus 312 (36.0%) NAC + RC. NAC + RC rates increased over time (EAPC =+ 6.1%, P = .001). Cumulative incidence plots derived five-year CSM rates were 40.3% in NAC + RC versus 36.1% in RC + ADJ patients ( P = .2). In multivariable CRR models that also adjusted for OCM, no statistically significant difference in CSM was recorded when NAC + RC was compared to RC + ADJ (HR:0.85, P = .1). Virtually the same observations were made in subgroup analyses where CSM associated with NAC + RC was not different from that recorded in RC + ADJ (HR: 0.89 and P = .4 in T3 stage and HR:0.8 and P = .2 in T4 stage). Conclusion: In locally-advanced UCUB, NAC rates have sharply increased overtime. However, the approach based on neoadjuvant chemotherapy prior to RC have not resulted in a statistically significant CSM benefit relative to RC +ADJ. Clinical Genitourinary Cancer, Vol. 22, No. 5, 102132 (c) 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.