Evidence map›Paper›PMID 40159560›Full record

ArticleWorld journal of urology2025

Perioperative cisplatin-based chemotherapy for muscle-invasive bladder cancer: a decision analysis.

Luca Afferi, Beate Jahn, Amar H Kelkar, Stijntje W Dijk, Zach M Feldman, Zachary J Ward, Marco Moschini, Richard Cathomas, Joaquim Bellmunt, Andrea Gallioli and 5 more

Abstract read
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In one paragraph

Article in World journal of urology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

15 authors.

Luca AfferiHarvard T. H. Chan School of Public Health, Boston, MA, USA. luca.afferi@gmail.com.
Beate JahnDepartment of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria.
Amar H KelkarDepartment of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA.
Stijntje W DijkDepartment of Radiology and Nuclear Medicine, Department of Epidemiology and Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands.
Zach M FeldmanDivision of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA.
Zachary J WardCenter for Health Decision Science, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
Marco MoschiniUnit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.
Richard CathomasDepartment of Medical Oncology, Kantonsspital Graubünden, Chur, Switzerland.
Joaquim BellmuntDepartment of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Andrea GallioliDepartment of Urology, Fundació Puigvert, Barcelona, Spain.
Alberto BredaDepartment of Urology, Fundació Puigvert, Barcelona, Spain.
Christian D FankhauserDepartment of Urology, Luzerner Kantonsspital, Lucerne, Switzerland.
Agostino MatteiDepartment of Urology, Luzerner Kantonsspital, Lucerne, Switzerland.
Steven L ChangHarvard Medical School, Boston, MA, 02215, USA.
Uwe SiebertDepartment of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeWhile meta-analyses of randomised studies suggest that neoadjuvant (NAC) or adjuvant (ACT) cisplatin-based chemotherapy improve overall survival in patients with muscle-invasive bladder cancer (MIBC), there are no trials comparing NAC against ACT in terms of quality-adjusted life years (QALYs) and costs. We aimed to evaluate the long-term QALYs, costs, and cost-effectiveness of different strategies for treating patients with MIBC.

methodsAn individual-level state transition microsimulation model was developed for patients with urothelial non-metastatic MIBC eligible for surgery and NAC at diagnosis. Four treatment strategies were evaluated: (i) no treatment, (ii) radical cystectomy (RC) without perioperative chemotherapy, (iii) NAC followed by RC, and (iv) RC followed by ACT. Primary endpoints were QALYs and costs. Sensitivity analysis on the probability of being fit for ACT after surgery was conducted to account for the uncertainty of this parameter. The model was face-validated independently by two urologists.

resultsLife-expectancy was 4.54 QALYs for ACT, 4.38 QALYs for NAC, 4.28 QALYs for RC without perioperative chemotherapy, and 2.84 QALYs for no treatment. Costs were lowest for ACT (US$45,805), compared to NAC (US$48,160), RC without perioperative chemotherapy (US$48,703), and no treatment (US$59,948). Sensitivity analysis suggested that NAC is associated with increased QALYs compared to ACT if the estimated probability of being fit for ACT is less than 38%. Limitations include the US-centric cost perspective.

conclusionsIn lack of comparative studies, simulated data suggests that ACT leads to increased QALYs and is cost-effective compared to NAC.

Indexed as

Antineoplastic AgentsCarcinoma, Transitional CellCisplatinDecision Support TechniquesUrinary Bladder NeoplasmsChemotherapy, AdjuvantCost-Benefit AnalysisCystectomyHumansNeoadjuvant TherapyNeoplasm InvasivenessPerioperative CareQuality-Adjusted Life YearsAntineoplastic AgentsCisplatinAdjuvant chemotherapyBladder cancerCisplatinCost-effectivenessDecision analysisNeoadjuvant chemotherapy

Identifiers

PMID40159560

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.