Neoadjuvant chemotherapy (NAC) is underutilized in the treatment of bladder cancer (BC).
To investigate the effect of NAC on the risk of surgical complications for radical cystectomy (RC) in a population-based setting.
All radical cystectomies performed in Finland during 2005-2014 were included in the study. Data were collected retrospectively using a web-based data collection platform. Complications were recorded for 90 d using the Clavien classification. Patients treated with NAC were compared to patients receiving RC alone using three cohorts and approaches: the entire cohort, a neoadjuvant period cohort, and a matched cohort.
For all three cohorts, odds ratios (ORs) were estimated using simple binary logistic regression. In addition, a multivariable stratified logistic model with propensity score was used. For the matched cohort analysis, both univariate and adjusted analyses were carried out.
During 2005-2014, 1427 RCs were performed in Finland, of which 1385 were included in the analyses. NAC was introduced in 2008, and 231 patients (16%) were assigned to NAC and 214 (15%) received two or more cycles of chemotherapy. Within 90 d, 61% of patients experienced complications and mortality was 4% (1.9% in the NAC group, and 4.4% in the RC-alone group). In simple binary logistic regression, NAC patients had significantly fewer complications, but this was not observed in multivariable or propensity score analyses. In the matched cohort analyses, no differences in complication rates could be observed. None of the analyses demonstrated higher complication rates in the NAC group.
Our retrospective study reports on nationwide use of NAC for BC and demonstrates that NAC does not increase RC morbidity.
Chemotherapy given before radical surgery does not increase severe postoperative complications in the treatment of bladder cancer.
European urology oncology. 2018 Jul 14 [Epub]
Antti P Salminen, Ilmari Koskinen, Ileana Montoya Perez, Saija Hurme, Teemu J Murtola, Markku H Vaarala, Timo K Nykopp, Marjo Seppänen, Taina Isotalo, Timo Marttila, Lasse Levomäki, Sebastian Becker, Mikael Anttinen, Tapani Liukkonen, Matti Säily, Dimitri Pogodin-Hannolainen, Jouko Viitanen, Christian Palmberg, Juhani Ottelin, Jukka Sairanen, Otto O Ettala, Peter J Boström
Department of Urology, University of Turku and Turku University Hospital, Turku, Finland. Electronic address: ., Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland., Department of Information Technology, University of Turku, Turku, Finland., Department of Biostatistics, University of Turku, Turku, Finland., Department of Urology, University of Tampere and Tampere University Hospital, Tampere, Finland., Department of Urology, University of Oulu and Oulu University Hospital, Oulu, Finland., Department of Urology, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland., Department of Surgery, Division of Urology, Central Hospital of Pori, Pori, Finland., Department of Surgery, Division of Urology, Central Hospital of Lahti, Lahti, Finland., Department of Surgery, Division of Urology, Central Hospital of Seinäjoki, Seinäjoki, Finland., Department of Surgery, Division of Urology, Central Hospital of Jyväskylä, Jyväskylä, Finland., Department of Surgery, Division of Urology, Central Hospital of Lappeenranta, Lappeenranta, Finland., Department of Surgery, Division of Urology, Central Hospital of Mikkeli, Mikkeli, Finland., Department of Surgery, Division of Urology, Central Hospital of Rovaniemi, Rovaniemi, Finland., Department of Surgery, Division of Urology, Central Hospital of Hämeenlinna, Hämeenlinna, Finland., Department of Surgery, Division of Urology, Central Hospital of Joensuu, Joensuu, Finland., Department of Surgery, Division of Urology, Central Hospital of Vaasa, Vaasa, Finland., Department of Surgery, Division of Urology, Central Hospital of Kemi, Kemi, Finland., Department of Urology, University of Turku and Turku University Hospital, Turku, Finland.