Neoadjuvant cisplatin-based chemotherapy (NAC) confers a survival benefit in muscle-invasive bladder cancer (MIBC), however a relevant proportion of patients experience early disease recurrence following radical cystectomy. We conducted a multicenter observational study to evaluate clinical, pathological, and laboratory factors associated with early recurrence defined as disease-free survival [DFS] ≤ 12 months in patients with MIBC treated with neoadjuvant cisplatin plus gemcitabine followed by radical cystectomy. Early recurrence was significantly associated with aggressive pathological features, including higher ypT stage, nodal involvement, lymphovascular invasion, and lower rates of pathological complete response. Patients experiencing early recurrence predominantly presented with systemic dissemination and had significantly shorter DFS and overall survival (OS). Variant histology and the presence of post-treatment lymphovascular invasion were independently associated with early recurrence. Early recurrence after NAC identifies a subgroup of patients with aggressive clinicopathological features and poorer oncological outcomes, highlighting the need for improved postoperative risk stratification and novel perioperative treatment strategies.
Scientific reports. 2026 Jun 19 [Epub ahead of print]
Giandomenico Roviello, Elisabetta Gambale, Roberta Giorgione, Umberto Basso, Maria Oliveri, Malvina Cremante, Francesco Atzori, Sarah Scagliarini, Cristina Masini, Valentina Baldazzi, Federico Scolari, Marinella Micol Mela, Eleonora Lai, Ismaela Anna Vascotto, Virginia Rossi, Chiara Calandrelli, Daniele Rossini, Daniele Lavacchi, Sergio Serni, Andrea Minervini, Serena Pillozzi, Lorenzo Antonuzzo
Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy. ., Oncology Unit, Careggi University Hospital, Florence, Italy., Oncology Unit 1, Istituto Oncologico Veneto, IOV-IRCCS, Padova, Italy., Medical Oncology Unit 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy., U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy., Medical Oncology, ASL Sulcis Iglesiente, Sirai Carbonia, Italy., Medical Oncology Unit, Azienda Ospedaliera di Rilievo Nazionale Cardarelli di Napoli, Naples, Italy., Medical Oncology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy., Department of Medical Oncology, Santa Maria Annunziata Hospital, Florence, Italy., Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy., Oncology Unit 3, Istituto Oncologico Veneto, IOV-IRCCS, Padova, Italy., Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.