İlkin Hamid-Zada, Özgür Arıkan, Özgür Kazan, Mehmet Çağlar Çakıcı, Asıf Yıldırım
Bulletin of Urooncology - 2025;24(4):103-108
Objective: For eligible patients with muscle-invasive bladder cancer, the current standard of care is neoadjuvant chemotherapy (NAC) using cisplatin-based regimens followed by radical cystectomy (RC) with pelvic lymph node dissection. We evaluated the role of NAC in the pathological T-staging of tumors in patients who underwent RC and the effect of pathological T-stage regression on disease-free survival (DFS) and overall survival (OS). Materials and Methods: We evaluated 29 patients who underwent RC following NAC between 2015 and 2023 at our hospital. Eligible participants had histologically confirmed urothelial carcinoma of the bladder with stage cT2-T4a N0-N2 M0 disease and had received cisplatin-based NAC. The primary endpoint was the effect of NAC on pathological T-stage regression, DFS, and OS. The secondary endpoint was to determine the factors affecting DFS following RC. Results: Cystectomy pN0 rate, in patients with T regression, was significantly higher than that in the other group (86.7% vs. 42.9%, p=0.021). The rate of lymphovascular invasion following cystectomy was significantly lower in the T regression group (57.1%) compared to the non-T regression group (93.3%; p=0.023). T2 pathology to RC time (hazard ratio=1.620, 95% confidence interval: 1.004-2.613, p<0.048) was the only independent predictor for DFS following RC in the multivariate analysis. Conclusion: Detection of pathological tumor regression in cystectomy pathology after NAC is associated with better DFS and OS. T2 pathology to RC time was an independent predictor of DFS.
