Effectiveness of Neoadjuvant Chemotherapy for Muscle-invasive Bladder Cancer in the Current Real World Setting in the USA.

摘要: Abstract Background The use of neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) is supported by results from several randomized control trials, including SWOG-8710. Objective To look at the effectiveness NAC RC in current real world practice USA. Design, setting, and participants We used National Cancer Data Base (NCDB) to identify patients with nonmetastatic muscle-invasive urothelial carcinoma bladder who underwent between 2004 2012. Intervention Receipt RC. Outcome measurements statistical analysis primary endpoint was overall survival (OS). Secondary endpoints were rates complete pathologic response (pT0), positive lymph nodes (pN+), margin status. Using a landmark adjust for an immortal-time bias, OS comparison performed using Cox regression analysis. Furthermore, logistic models examining secondary outcomes fitted. potential selection propensity score–weighted analyses performed. Results limitations Of 8732 RC, 1619 (19%) received NAC. Following score adjustment, receipt not associated benefit (hazard ratio 0.97; p = 0.591). On outcome analysis, higher pT0 (odds 5.03; p  Conclusions Important baseline differences SWOG-8710 trial those general urologic exist. After adjusting we did find clear advantage when compared alone urology Patient summary few trials. In this study, large national data set USA found that preoperative all practice. Hence, better criteria are needed determine will most cystectomy.