Effect of Neoadjuvant Chemotherapy on Complications, in-Hospital Mortality, Length of Stay and Total Hospital Costs in Bladder Cancer Patients Undergoing Radical Cystectomy

SIMPLE SUMMARY: Current guidelines recommend neoadjuvant chemotherapy (NAC) in muscle invasive, urothelial carcinoma of the urinary bladder patients treated with radical cystectomy (RC). However, large-scaled, contemporary data investigating the usage and effect of neoadjuvant chemotherapy prior to radical cystectomy on perioperative outcomes are scarce. We identified 4347 bladder cancer patients treated with RC between 2016 and 2019, relying on the National (Nationwide) Inpatient Sample (NIS) database. Of those, 805 (19%) received NAC. No differences for overall complication were recorded between RC patients treated with NAC vs. without. Specifically, NAC patients depicted lower rates of wound, cardiac, pulmonary and genitourinary complications. In line with this, in-hospital mortality rates as well as the length of stay were in favor for NAC patients. By contrast, NAC was associated with moderately higher total hospital costs. The current study recorded no detriment from NAC in the context of RC; however, the current study recorded persistently low rates of NAC contrary to current guidelines. ABSTRACT: Background: To test for differences in complication rates, in-hospital mortality, length of stay (LOS) and total hospital costs (THCs) in patients treated with neoadjuvant chemotherapy (NAC) prior to radical cystectomy (RC). Methods: Within the National (Nationwide) Inpatient Sample (NIS) database (2016–2019), we identified RC-treated, non-metastatic, lymph-node negative bladder cancer patients, stratified by NAC status. Trend analyses, multivariable logistic, multivariable Poisson and multivariable linear regression models were used. Results: We identified 4347 RC-treated bladder cancer patients. Of those, 805 (19%) received NAC prior to RC. Overall, complications rates did not differ (65 vs. 66%; p = 0.7). However, NAC patients harbored lower rates of surgical site (6 vs. 9%), cardiac (13 vs. 19%) and genitourinary (5.5 vs. 9.7%) complications. In-hospital mortality (<1.7 vs. 1.8%) and LOS (6 vs. 7 days) was lower in NAC patients (all p < 0.05). Moreover, NAC was an independent predictor of shorter LOS in multivariable Poisson regression models (Risk ratio: 0.86; p < 0.001) and an independent predictor for higher THCs in multivariable linear regression models (Odds ratio: 1474$; p = 0.02). Conclusion: NAC was not associated with higher complication rates and in-hospital mortality. Contrary, NAC was associated with shorter LOS, yet moderately higher THCs. The current analysis suggests no detriment from NAC in the context of RC.