University of Hertfordshire

By the same authors

  • David D'Andrea
  • Peter C. Black
  • Homayoun Zargar
  • C. P. Dinney
  • Francesco Soria
  • M. S. Cookson
  • Jeffrey S Montgomery
  • Wassim Kassouf
  • Marc A Dall'Era
  • Srikala S. Sridhar
  • John S McGrath
  • Jonathan Wright
  • Andrew C. Thorpe
  • J. M. Holzbeierlein
  • Diego Carrión
  • Ettore Di Trapani
  • Trinity J Bivalacqua
  • Scott North
  • Daniel A Barocas
  • Yair Lotan
  • Petros Grivas
  • Andrew J Stephenson
  • Bas W van Rhijn
  • Siamak Daneshmand
  • Philippe E Spiess
  • Shahrokh F Shariat
  • Kamran Zargar-Shoshtari
  • Laura S Mertens
  • Adrian S Fairey
  • Maria C Mir
  • Laura-Maria Krabbe
  • Niels-Erik Jacobsen
  • Evan Y Yu
  • Evanguelos Xylinas
  • Benjamin Pradere
  • Renate Pichler
  • Nicholas J Campain
  • J. A. Seah
  • C. E. Ercole
  • Simon Horenblas
  • J. Aning
  • Todd M Morgan
  • Jay B Shah
  • Marco Moschini
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Original languageEnglish
Number of pages7
JournalJournal of Urology
Publication statusE-pub ahead of print - 27 Aug 2021


Purpose: To investigate the pathologic response rates and survival associated with 3 versus 4 cycles of cisplatin-based NAC in patients with cT2-4N0M0 MIBC.

Material and methods: In this cohort study we analyzed clinical data of 828 patients treated with NAC and RC between 2000 and 2020. A total of 384 and 444 patients were treated with 3 and 4 cycles of NAC, respectively. Pathologic objective response (pOR; ypT0-Ta-Tis-T1 N0), pathologic complete response (pCR; ypT0 N0), cancer-specific survival (CSS) and overall survival (OS) were investigated.

Results: pOR and pCR were achieved in 378 (45%; 95%CI 42, 49) and 207 (25%; 95%CI 22, 28) patients, respectively. Patients treated with 4 cycles of NAC had higher pOR (49% vs 42%, p=0.03) and pCR (28% vs 21%, p=0.02) rates compared to those treated with 3 cycles. This effect was confirmed on multivariable logistic regression analysis (pOR OR 1.46 p=0.008, pCR OR 1.57,p=0.007). On multivariable Cox regression analysis, 4 cycles of NAC were significantly associated with OS (HR 0.68; 95%CI 0.49, 0.94; p=0.02) but not with CSS (HR 0.72; 95%CI 0.50, 1.04; p=0.08).

Conclusions: 4 cycles of NAC achieved better pathologic response and survival compared to 3 cycles. These findings may aid clinicians in counselling patients and serve as a benchmark for prospective trials. Prospective validation of these findings and assessment of cumulative toxicity derived from an increased number of cycles are needed.


© 2021 by American Urological Association Education and Research, Inc.

ID: 25855508