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. 2025 Jan-Mar;41(1):20-27.
doi: 10.4103/iju.iju_214_24. Epub 2025 Jan 1.

Oncological outcomes and complications following radical cystectomy with or without neoadjuvant chemotherapy - A retrospective comparative cohort study from a single-center in South India

E Selvin Theodore Jayanth  1 , Subhash L Jat  1 , Benedict P Samuel  1 , Ashish Singh  2 , Nirmal Thampi John  1 , Anjana Joel  2 , Rajiv Paul Mukha  1 , Grace Rebecca  3 , Gowri Mahasampath  3 , Chandrasingh Jeyachandra Berry  1 , Antony Devasia  1 , Nitin Kekre  4 , Santosh Kumar  1
Affiliations

Oncological outcomes and complications following radical cystectomy with or without neoadjuvant chemotherapy - A retrospective comparative cohort study from a single-center in South India

E Selvin Theodore Jayanth et al. Indian J Urol. 2025 Jan-Mar.

Abstract

Introduction: Neoadjuvant chemotherapy (NAC) in the management of muscle-invasive bladder carcinoma has not been adopted universally. We studied the oncological outcomes and complications in patients who underwent radical cystectomy (RC) with or without NAC.

Methods: A retrospective review of patients who underwent RC with or without NAC from June 2009 to June 2020 was conducted. Oncological outcomes, overall survival (OS) and recurrence-free survival (RFS), complications, and prognostic factors were analyzed.

Results: Of the 314 patients who underwent RC, 83 patients received NAC (Group A), and 231 underwent RC alone (Group B). The median age was 58 years. The median follow-up duration was 22 (3-64) and 24 (3-62) months, respectively. The median OS in Group A was significantly higher than Group B (38 months [confidence interval (CI): 34-42] and 32 [CI: 29-35], respectively, [P = 0.033]). The RFS in Groups A and B was 34 (CI: 30-39) and 31 (CI: 28-34) months, respectively (P = 0.47). Higher pathological T stage (T3/4), node positivity and lymphovascular invasion (LVI) were predictors of poor OS and RFS (P < 0.0001). Clavien grades 3/4 complications were comparable (8% vs. 15%; P = 0.19). Glomerular filtration rate (GFR) <60 mL/min/1.73 m2 was associated with higher postoperative complications in both groups (P = 0.012).

Conclusion: The OS with NAC was superior to upfront RC. RFS was, however, comparable. NAC was safe and well-tolerated. Pathologically, higher T stage, node positivity, and LVI were associated with poorer OS and RFS. Low GFR negatively influenced postoperative complications.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
The overall survival following radical cystectomy with or without neoadjuvant chemotherapy: (stratified based on T stage, nodal status, and pathological response). OS = Overall survival, NACT – Neoadjuvant Chemotherapy
Figure 2
Figure 2
Recurrence-free survival following radical cystectomy with or without neoadjuvant chemotherapy: (stratified based on T stage, nodal status, and pathological response). rFS = Recurrence-free survival
See this image and copyright information in PMC

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