Introduction: Neoadjuvant chemotherapy (NAC) represents a standard of care prior to radical cystectomy for muscle-invasive bladder cancer (MIBC; =cT2). While NAC utilization has increased over time in the United States, many patients may not receive NAC due to reasons that are difficult to identify in administrative or registry data. We aimed to assess utilization of NAC and etiologies for lack of NAC receipt among consecutive patients at a single institution.
Methods: Patients diagnosed with bladder cancer and undergoing radical cystectomy at Loyola University Medical Center (2005-2021) were included. Clinical variables included age, sex, race, comorbidities, prior intravesical therapy, hydronephrosis, histology, clinical stage, and surgical approach. Patients were categorized by stage and receipt of NAC. Early and recent time periods were evaluated among all =cT2 patients and after exclusion of non-candidates. Reasons for no NAC were categorized. Overall survival (OS) was evaluated with Kaplan-Meier curves and multivariable Cox proportional hazards regression models.
Results: Of 589 evaluable patients, 380 (64.5%) had =cT2 disease and 209 (35.5%) Conclusions: NAC utilization increased over time with change in estimates before and after exclusion of non-candidates. Renal dysfunction, patient preference, and provider recommendation based on histologic or clinical concerns were primary etiologies for lack of NAC prior to radical cystectomy for muscle-invasive bladder cancer. Fewer patients refused NAC in recent years leading to a potential ceiling for NAC utilization.