Time to Treatment Initiation and Survival in Patients With Muscle-Invasive Bladder Cancer (MIBC)

Authors

• Andrea Piccolini, Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
• Marco Paciotti, Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
• Stephan M. Korn, Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, Medical University of Vienna, Vienna, Austria.
• Zhiyu Qian, Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
• Pietro Brin, Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
• Klara Pohl, Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, Medical University of Graz, Graz, Austria.
• Alexander P. Cole, MaineHealth

Document Type

Article

Publication Date

8-2026

Institution/Department

Urology

Journal Title

Clinical genitourinary cancer

MeSH Headings

Humans; Urinary Bladder Neoplasms (mortality, therapy, pathology); Female; Male; Aged; Cystectomy; Neoadjuvant Therapy; Time-to-Treatment (statistics & numerical data); Middle Aged; Treatment Delay; Retrospective Studies; Cisplatin (therapeutic use); Neoplasm Invasiveness; Chemotherapy, Adjuvant

Abstract

BACKGROUND: Timely initiation of definitive treatment is critical in muscle-invasive bladder cancer (MIBC). While cisplatin-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) is the standard of care, its real-world implementation remains limited. We evaluated the association between time-to-treatment initiation (TTI) and overall survival (OS) in MIBC. PATIENT AND METHODS: Using the National Cancer Database (2004-2022), we identified cT2-T4aN0M0 urothelial MIBC patients treated with RC with/without NAC. Patients were stratified into four groups: upfront RC within 60 days, upfront RC beyond 60 days, NAC within 60 days followed by RC, and NAC beyond 60 days followed by RC. Inverse probability of treatment weighting (IPTW) was applied. Weighted Kaplan-Meier and IPTW-adjusted Cox models estimated OS, reported as hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS: Among 16,517 eligible patients (median follow-up:49.7 months [IQR:20.8-95.2]), 39.1% underwent upfront RC within 60 days and 23.3% initiated NAC within 60 days. In cT2N0M0 disease, NAC initiated within 60 days was associated with improved OS compared with upfront RC ≤60 days (HR:0.79; 95%CI: 0.71-0.90; P< .001); delayed NAC showed no significant benefit (HR:0.83; 95%CI: 0.67-1.02; P=.08). In cT3-T4aN0M0 disease, delayed RC (>60 days) was associated with worse OS (HR:1.21; 95%CI: 1.03-1.41; P=.02); early NAC improved survival (HR:0.78; 95%CI: 0.67-0.92; P=.004). Sensitivity analyses confirmed consistent findings. CONCLUSION: TTI is a critical determinant of survival in MIBC. NAC initiated within 60-days from diagnosis retains its survival benefit, whereas longer delays do not confer improved outcomes. These findings highlight the need for timely multidisciplinary coordination and streamlined care pathways in MIBC.

First Page

102595

Recommended Citation

Piccolini, Andrea; Paciotti, Marco; Korn, Stephan M.; Qian, Zhiyu; Brin, Pietro; Pohl, Klara; and Cole, Alexander P., "Time to Treatment Initiation and Survival in Patients With Muscle-Invasive Bladder Cancer (MIBC)" (2026). MaineHealth Maine Medical Center. 4581.
https://knowledgeconnection.mainehealth.org/mmc/4581