Does Time to Adjuvant Chemotherapy after Radical Cystectomy Affect Survival in Muscle Invasive Bladder Cancer? A Systematic Review

SIMPLE SUMMARY: With enhanced recovery after surgery protocols, it is now possible to decrease a patient’s length of stay in the hospital and administer adjuvant chemotherapy earlier than before. Our study analyzed 7056 patients who underwent a radical cystectomy and subsequent adjuvant chemotherapy to determine if an earlier timing of adjuvant chemotherapy would affect survival outcomes. We found that earlier time to adjuvant therapy showed a survival benefit, and a benefit persisted regardless of timing when compared to controls. ABSTRACT: (1) Purpose: To assess the survival benefit for different times to adjuvant chemotherapy after a radical cystectomy. (2) Materials and Methods: We systematically searched PubMed(®), Cochrane Central(®), Scopus(®), and Web of Science(®) library databases for original articles that looked at timing to adjuvant chemotherapy after radical cystectomy. Primary endpoints were five-year survival, progression free survival, and overall survival. Available multivariable hazard ratios and corresponding 95% CIs were included in the qualitative analysis. The risk of bias was completed for nonrandomized studies. (3) Results: Using PRISMA guidelines, our electronic search resulted in a total of 1862 records. After a detailed review, we selected four studies that addressed the impact of the timing of adjuvant chemotherapy for patients who underwent radical cystectomy. (4) Conclusion: A survival benefit was seen with an earlier administration of adjuvant chemotherapy, albeit a benefit persists for delayed chemotherapy post-radical cystectomy. A safe and ethical approach at this time would be to administer adjuvant chemotherapy as early in the postoperative period as possible, given the known survival benefit of such therapy (9–11% absolute survival benefit at five years).