The long-term efficacy of one-shot neoadjuvant intra-arterial chemotherapy combined with radical cystectomy versus radical cystectomy alone for bladder cancer: a propensity-score matching study
Bladder cancer is a complex disease associated with high morbidity and mortality. The management of bladder cancer before radical cystectomy continues to be controversial. We compared the long-term efficacy of one-shot neoadjuvant intra-arterial chemotherapy (IAC)versus no IAC (NIAC) before radical cystectomy (RC) for bladder cancer. Methods: We performed a retrospective review of patients who underwent either one-shot IAC or NIAC before RC between October 2006 and November 2015.
... e matching (1:3) was performed based on key characteristics. The Kaplan-Meier method was utilized to estimate survival probabilities, and the log-rank test was used to compare survival outcomes between different groups. A multivariable Cox proportional hazards model was used to estimate survival outcomes. Results: Twenty-six patients were treated using IAC before RC, and 123 NIAC patients also underwent RC. After matching, there was no significant difference between the groups in baseline characteristics, perioperative variables, complication outcomes or tumour characteristics. Compared with the clinical tumour stages, the pathological tumour stages demonstrated a significant decrease (P=0.002) in the IAC group. There was no significant difference in overall survival (OS, p=0.354) or cancer-specific survival (CSS, p=0.439) between the groups. Among all patients, BMI significantly affected OS (p=0.004), and positive lymph nodes (PLN) significantly affected both OS(p 0.001) and CSS (p=0.010). Conclusions: One-shot neoadjuvant IAC before RC shows safety and tolerability and provides a significant advantage in pathological downstaging but not in OS or CSS. Further study of neoadjuvant combination therapeutic strategies with RC is needed.