Why is preoperative neoadjuvant chemotherapy not promoted for bladder cancer patients

Literature reports show that neoadjuvant chemotherapy before bladder cancer surgery can increase the 5-year overall survival rate of bladder cancer patients by 5%. An American scholar has described this data vividly, for example, 15,000 bladder cancer patients die in the United States each year. If the 5-year survival rate increases by 5%, it means that 750 more bladder cancer patients can survive each year, or 3,750 bladder cancer patients will still be alive in 5 years. Therefore, neoadjuvant chemotherapy before bladder cancer surgery is worthwhile.

But even in the United States, where medical care is advanced, less than 2% of patients with muscle-invasive bladder cancer receive neoadjuvant chemotherapy. This is due to some misunderstandings.

1. Patients with localized and small-volume invasive bladder cancer prefer complete bladder resection and lymph node dissection for better treatment results.

2. Chemotherapy may change the initial pathological staging results.

3. Chemotherapy delays final surgery and leads to disease progression in patients with bladder cancer who are unresponsive to chemotherapy.

4. Chemotherapy increases perioperative complications.

5. Chemotherapy is associated with morbidity and possibly mortality, increasing costs and patient inconvenience.

6. The benefits of neoadjuvant chemotherapy are limited, increasing the 5-year survival rate of bladder cancer patients by only 5%.

7. Patients’ opinions and complications limit the application of neoadjuvant chemotherapy.

8. Narrow clinical factors, such as tumor size, hydronephrosis, lymphovascular invasion, and mixed histological pathological findings, clearly indicate the use of neoadjuvant chemotherapy in patients with bladder tumors who are at high risk of metastasis.