MP23-05: Effect of neoadjuvant chemotherapy in improving overall survival of T2-4aN0M0 bladder cancer patients: A systemic review and meta-analysis according to EAU COVID-19 recommendation

Dong Hyuk Kang*, Incheon, Korea, Republic of, Jae Yong Jeong, Young Joon Moon, Seoul, Korea, Republic of, Doo Yong Chung, Incheon, Korea, Republic of, Hyun Ho Han, Seoul, Korea, Republic of, Hae Do Jung, Gunpo, Korea, Republic of, Kang Su Cho, Joo Yong Lee, Seoul, Korea, Republic of

Introduction: In situation with the COVID-19 outbreak, the EAU guidelines Rapid Reaction Group provided recommendations to guide muscle invasive bladder cancer (MIBC) priorities, and they recommended that neoadjuvant chemotherapy should be considered omitted in T2/3 focal N0M0 MIBC patients. This meta-analysis aims to evaluate the efficacy of neoadjuvant chemotherapy compared to radical cystectomy alone in improving overall survival of T2-4aN0M0 MIBC patients.

Methods: Following the PRISMA guideline, PubMed, EMBASE, and Cochrane Library were searched up to September 2021. The articles were searched with keywords “muscle-invasive bladder cancer”, “neoadjuvant chemotherapy”, “cystectomy”, and “overall survival”. Participants, patients with T2-4aN0M0 MIBC; Interventions, T2-4aN0M0 MIBC patients who underwent neoadjuvant chemotherapy; Outcomes, comparison of overall survival included for analysis. The overall survival was analyzed as hazard ratio (HR) and 95% confidence interval (CI) and presented in a forest plot. We also conducted a sub-analysis of only T2N0M0 MIBC patients. Quality assessments were performed independently by two reviewers using the Scottish Intercollegiate Guidelines Network.

Results: A total of 8 studies were included in the meta-analysis. 8 studies were intermediate risk for detection bias and there were no major problems. In T2-4aN0M0 MIBC patients, the overall survival was significantly better in the neoadjuvant chemotherapy + radical cystectomy group than in the radical cystectomy alone group (HR, 0.79; 95% CI, 0.69–0.92; p=0.002) (Fig. 1A). A subgroup analysis was performed on only T2N0M0 MIBC patients and 5 studies were included. There was no difference in overall survival between the neoadjuvant chemotherapy + radical cystectomy group and the radical cystectomy alone group (HR, 0.83; 95% CI, 0.69–1.02; p=0.06) (Fig. 1B).

Conclusions: As recommended by the EAU guidelines Rapid Reaction Group, it is thought that patients with T2N0M0 MIBC should strongly consider omitting neoadjuvant chemotherapy until the end of the COVID-19 pandemic. Whether to omit neoadjuvant in T2-4aN0M0 MIBC should be discussed further, and studies targeting only T2-3N0M0 MIBC are expected to proceed further.

Source of Funding: None.