Our systematic review and meta-analysis evaluated the impact of the timing of AC administration on survival outcomes in patients with MIBC post-radical cystectomy. The analysis included five studies with over 2,400 patients, categorizing them by AC initiation within 45 or 90 days of surgery. The findings were compelling: earlier administration of AC resulted in a significantly improved overall survival (OS) and progression-free survival (PFS) compared to delayed AC. For example, patients who received AC within 45 days demonstrated a hazard ratio (HR) for OS of 1.27, while those treated within 90 days had an HR of 1.17, highlighting the time-sensitive nature of adjuvant treatment.
This study supports the early initiation of AC to reduce the risks associated with disease progression. It also aligns with enhanced recovery after surgery (ERAS) protocols, potentially allowing us to provide therapy sooner, optimizing recovery and expediting AC delivery. Although retrospective studies introduce limitations, this meta-analysis underscores the need for timely AC in improving survival rates in MIBC patients.
Further prospective trials are warranted to refine these findings and explore the role of emerging therapies such as immunotherapy in the adjuvant setting. The potential for therapies like nivolumab to enhance survival further reinforces the evolving landscape of MIBC treatment, making early intervention crucial for improving long-term outcomes.
Written by:
- Gal Saffati, MD, Scott Department of Urology, Baylor College of Medicine, Houston, TX
- Shane Kronstedt, MD, Scott Department of Urology, Baylor College of Medicine, Houston, TX