Academic Journal
Time to Treatment Initiation and Survival in Patients With Muscle-Invasive Bladder Cancer (MIBC).
| Τίτλος: | Time to Treatment Initiation and Survival in Patients With Muscle-Invasive Bladder Cancer (MIBC). |
|---|---|
| Συγγραφείς: | Piccolini A; Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy., Paciotti M; Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy., Korn SM; Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, Medical University of Vienna, Vienna, Austria., Qian Z; Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA., Brin P; Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy., Pohl K; Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, Medical University of Graz, Graz, Austria., Zurl H; Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, Medical University of Graz, Graz, Austria., Xiao B; Boston University Chobanian and Avedisian School of Medicine, Boston, MA., Lipsitz S; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA., Preston MA; Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA., Lughezzani G; Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy., Buffi NM; Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy., Trinh QD; Department of Urology, University of Pittsburgh, Pittsburgh, PA., Cole AP; Department of Urology, MaineHealth Pen Bay Hospital, Rockport, ME; Tufts University School of Medicine, Boston, MA. Electronic address: alexander.p.cole@gmail.com. |
| Πηγή: | Clinical genitourinary cancer [Clin Genitourin Cancer] 2026 Aug; Vol. 24 (5), pp. 102595. Date of Electronic Publication: 2026 Jun 05. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Elsevier Country of Publication: United States NLM ID: 101260955 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1938-0682 (Electronic) Linking ISSN: 15587673 NLM ISO Abbreviation: Clin Genitourin Cancer Subsets: MEDLINE |
| Imprint Name(s): | Publication: <2009-> : [New York] : Elsevier Original Publication: Dallas, Tex. : Cancer Information Group, c2005- |
| Ιατρικοί όροι (MeSH): | Urinary Bladder Neoplasms*/mortality , Urinary Bladder Neoplasms*/therapy , Urinary Bladder Neoplasms*/pathology , Time-to-Treatment*/statistics & numerical data , Cystectomy*, Cisplatin/therapeutic use ; Humans ; Female ; Male ; Aged ; Neoadjuvant Therapy ; Middle Aged ; Treatment Delay ; Retrospective Studies ; Neoplasm Invasiveness ; Chemotherapy, Adjuvant |
| Περίληψη: | Background: Timely initiation of definitive treatment is critical in muscle-invasive bladder cancer (MIBC). While cisplatin-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) is the standard of care, its real-world implementation remains limited. We evaluated the association between time-to-treatment initiation (TTI) and overall survival (OS) in MIBC. Patient and Methods: Using the National Cancer Database (2004-2022), we identified cT2-T4aN0M0 urothelial MIBC patients treated with RC with/without NAC. Patients were stratified into four groups: upfront RC within 60 days, upfront RC beyond 60 days, NAC within 60 days followed by RC, and NAC beyond 60 days followed by RC. Inverse probability of treatment weighting (IPTW) was applied. Weighted Kaplan-Meier and IPTW-adjusted Cox models estimated OS, reported as hazard ratios (HRs) with 95% confidence intervals (CIs). Results: Among 16,517 eligible patients (median follow-up:49.7 months [IQR:20.8-95.2]), 39.1% underwent upfront RC within 60 days and 23.3% initiated NAC within 60 days. In cT2N0M0 disease, NAC initiated within 60 days was associated with improved OS compared with upfront RC ≤60 days (HR:0.79; 95%CI: 0.71-0.90; P<.001); delayed NAC showed no significant benefit (HR:0.83; 95%CI: 0.67-1.02; P=.08). In cT3-T4aN0M0 disease, delayed RC (>60 days) was associated with worse OS (HR:1.21; 95%CI: 1.03-1.41; P=.02); early NAC improved survival (HR:0.78; 95%CI: 0.67-0.92; P=.004). Sensitivity analyses confirmed consistent findings. Conclusion: TTI is a critical determinant of survival in MIBC. NAC initiated within 60-days from diagnosis retains its survival benefit, whereas longer delays do not confer improved outcomes. These findings highlight the need for timely multidisciplinary coordination and streamlined care pathways in MIBC. (Copyright © 2026 Elsevier Inc. All rights reserved.) |
| Competing Interests: | Disclosure APC: reports research funding from the Bruce A Beal and Robert L Beal surgical fellowship of the BWH Department of Surgery, from the Prostate Cancer Foundation and American Cancer Society (#23YOUN25), from a Physician Research Award from the Department of Defense Congressionally Directed Medical Research Program (#PC220342), proctoring fees from EDAP/TMS, and personal fees from UpToDate. QDT: reports consulting fees from Astellas, Bayer, Intuitive Surgical, Janssen, Novartis, Pfizer, and research funding from the American Cancer Society, Pfizer Global Medical Grants (Prostate Cancer Disparities #63354905), and a Health Disparity Research Award from the Department of Defense Congressionally Directed Medical Research Program (#PC220551). SMK: reports speaker fees from Janssen, Astellas and research fund from the Max Kade foundation/Austrian Academy of Science. The other coauthors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. |
| Contributed Indexing: | Keywords: Bladder cancer; Neoadjuvant chemotherapy; Radical cystectomy; Surgery delay; Urothelial carcinoma |
| Substance Nomenclature: | Q20Q21Q62J (Cisplatin) |
| Entry Date(s): | Date Created: 20260703 Date Completed: 20260714 Latest Revision: 20260714 |
| Update Code: | 20260714 |
| DOI: | 10.1016/j.clgc.2026.102595 |
| PMID: | 42399133 |
| Βάση Δεδομένων: | MEDLINE |
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