Neoadjuvant gemcitabine and carboplatin followed by immediate cystectomy may be associated with a survival benefit in patients with clinical T2 bladder cancer

Neoadjuvant cisplatin-based chemotherapy for muscle-invasive bladder cancer (MIBC) is more beneficial for clinical T3/4 than clinical T2 (cT2) disease. The aim of this study was to assess whether neoadjuvant GCarbo has a survival impact on cT2 bladder cancer. We retrospectively reviewed the medical records of 363 consecutive patients who underwent radical cystectomy (RC) between April 1997 and May 2012. We focused on 150 patients with cT2 MIBC. Seventy-nine patients received neoadjuvant GCarbo between March 2005 and April 2013. These patients received two courses of GCarbo and RC, and bilateral pelvic lymph node dissection (PLND) was performed at an interval of 1 month after chemotherapy. The control cohort included 71 patients with cT2 bladder cancer treated with RC and bilateral PLND alone between May 1994 and May 2007. Propensity score matching was used to adjust for potential selection biases associated with the treatment types. The endpoints were overall (OS), disease-specific (DSS), and disease-free survival (DFS). Propensity score-matched analysis resulted in 71 matched pairs from both groups. The 5-year OS rate was 98.6% for the neoadjuvant GCarbo group and 66.6% for the RC-alone group (p < 0.0001). The 5-year DSS rate was 100% for the neoadjuvant GCarbo group and 69.7% for the RC-alone group (p < 0.0001). The 5-year DFS rate was 94.2% for the neoadjuvant GCarbo group and 72.7% for the RC-alone group (p < 0.0001). In cT2 MIBC patients, neoadjuvant GCarbo chemotherapy followed by immediate cystectomy may improve OS and DFS compared to RC alone.