Comparative Analysis of the Efficacy of Neoadjuvant Therapy on Primary Lesions and Metastatic Lesions in Bladder Cancer: A Multicenter Retrospective Study
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Background Neoadjuvant therapy (NAT) plays a significant role in bladder cancer (BC) treatment, but comparative data on its efficacy between primary and metastatic lesions are limited. This study aims to compare the treatment response between primary and metastatic lesions and to analyze the impact of clinical characteristics, treatment regimens, and histological types on such differences. Methods This multicenter retrospective study included BC patients with evaluable metastatic lesions who received NAT followed by radical cystectomy with bilateral pelvic lymph node dissection. Treatment response was assessed using TNM staging combined with imaging for both primary and metastatic lesions. Statistical analyses were performed using R software. Results Among 72 eligible patients, the overall response rate of primary lesions (73.61%) was higher than that of metastatic lesions (63.89%) and pelvic lymph node metastases (64.41%). Significant differences in treatment efficacy were observed between primary lesions and metastatic lesions ( P = 0.046), and the difference was even greater between primary lesions and pelvic lymph node metastases ( P = 0.034). Variant histology (OR = 12.40, P < 0.001) and smoking history (OR = 5.31, P = 0.02) were significant factors influencing efficacy differences. The integrated T-stage and size assessment reclassified primary tumor response in 6 patients (8.33%) and showed better consistency than conventional RECIST criteria (Kappa: 0.24 vs. 0.19). Conclusion NAT efficacy significantly differed between primary and metastatic lesions, as well as between primary lesions and pelvic lymph node metastases in BC. Variant histology and smoking history were independent predictors of such differences. In terms of efficacy assessment methodology, the novel "T-stage and size integrated evaluation" method provided more accurate primary tumor response assessment. This study offers important evidence for personalized treatment strategies in BC. Trial registration Clinical trial number: not applicable.
Source: Research Square
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7225429191