OBJECTIVES: To assess the efficacy of neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) in a retrospective multicentre cohort of patients with cT2N0M0 bladder cancer (BCa) without preoperative hydronephrosis. PATIENTS AND METHODS: This was a propensity-based analysis of 619 patients. Of these, 316 were treated with NAC followed by RC and 303 with upfront RC. After multiple imputations, inverse probability of treatment weighting (IPTW) was used to account for potential selection bias. Multivariable logistic regression analysis was performed to evaluate the impact of NAC on pathological complete response and downstaging at RC, while IPTW-adjusted Kaplan-Meier curves and Cox regression models were built to evaluate the impact of NAC on overall survival (OS). RESULTS: After IPTW-adjusted analysis, standardised differences between groups were <15%. A complete response (pT0N0) at final pathology was achieved in 94 (30%) patients receiving NAC and nine (3%) undergoing upfront RC. Downstaging to non-muscle-invasive disease (

Cross Cancer Institute Edmonton AB Canada

Department of Genitourinary Oncology H Lee Moffitt Cancer Center and Research Institute Tampa FL USA

Department of Hematology and Medical Oncology Taussig Cancer Institute Cleveland Clinic Cleveland OH USA

Department of Medicine Division of Oncology University of Washington School of Medicine and Fred Hutchinson Cancer Research Center Seattle WA USA

Department of Oncology University of Alberta Alberta AB Canada

Department of Surgery Exeter Surgical Health Services Research Unit Royal Devon and Exeter NHS Trust Exeter UK

Department of Surgery McGill University Health Center Montreal Canada

Department of Urologic Sciences University of British Columbia Vancouver BC Canada

Department of Urologic Surgery Vanderbilt University Medical Center Nashville TN USA

Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Urology Davis Medical Center University of California at Davis Sacramento CA USA

Department of Urology Freeman Hospital Newcastle Upon Tyne UK

Department of Urology MD Anderson Cancer Center Houston TX USA

Department of Urology Medical University of Vienna Vienna General Hospital Vienna Austria

Department of Urology Stanford University School of Medicine Stanford CA USA

Department of Urology The James Buchanan Brady Urological Institute The Johns Hopkins School of Medicine Baltimore MD USA

Department of Urology The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital Amsterdam The Netherlands

Department of Urology University of Kansas Medical Center Kansas City KS USA

Department of Urology University of Michigan Health System Ann Arbor MI USA

Department of Urology University of Oklahoma College of Medicine Oklahoma City OK USA

Department of Urology University of Texas Southwestern Medical Center Dallas TX USA

Department of Urology University of Washington Seattle WA USA

Department of Urology Weill Cornell Medical College Presbyterian Hospital New York NY USA

Division of Urology Department of Special Surgery Jordan University Hospital The University of Jordan Amman Jordan

Division of Urology Department of Surgical Sciences Torino School of Medicine Torino Italy

Glickman Urological and Kidney Institute Cleveland Clinic Cleveland OH USA

Institute for Urology and Reproductive Health 1 M Sechenov 1st Moscow State Medical University Moscow Russia

Princess Margaret Hospital Toronto ON Canada

University of Alberta Edmonton AB Canada

USC Norris Comprehensive Cancer Center Institute of Urology University of Southern California Los Angeles CA USA

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