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A population-based retrospective analysis on variation in use of neoadjuvant chemotherapy depending on comorbidity in patients with muscle-invasive bladder cancer undergoing cystectomy in Denmark in the period 2013–2019

Abstract Introduction The recommended treatment of localized muscle-invasive bladder cancer (MIBC) is cystectomy and neoadjuvant chemotherapy (NAC) for eligible patients. However, the percentage who receive NAC is varying. Objective The aim was to evaluate the variation in percentage of patients receiving NAC in Denmark since implementation in 2013, the potential influence of comorbidity on NAC administration, and the pathological outcome at time of cystectomy with and without NAC. Methods Patients were identified by cystectomy procedure codes and date of diagnosis in the period 2013–2019 in The Danish Bladder Cancer Database. Chi square test and Fisher’s exact test were used to evaluate demographics and tumor-specific characteristics. Wilcoxon rank-sum test was used to compare Charlson Comorbidity Index (CCI) and compare age-adjusted CCI subgroups. Results Overall, 1032 patients age ≤75 years and tumor stage ≥T2 were included in the study; 594 patients (58%) received NAC. The percentage of NAC administration varied from 27% to 92%. Patients who received NAC had significantly less comorbidity estimated by CCI when compared to patients not receiving NAC. Of patients with MIBC who received NAC, 57% had complete response (CR) at cystectomy, whereas 29% of patients who did not receive NAC had CR at cystectomy (p < 0.01). Conclusions Patients with comorbidity estimated by high CCI score had a lower probability of receiving NAC. The probability of CR was twice as high in patients with MIBC treated with NAC compared to patients undergoing cystectomy alone. However, almost one third of patients with MIBC were tumor free at cystectomy despite no NAC administration.