ArticleThe oncologist2026
The impact of relative dose intensity on pathological complete response in neoadjuvant chemotherapy of muscle-invasive urothelial cancer: a multicenter retrospective study.
Article in The oncologist, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCisplatin-based neoadjuvant chemotherapy (NAC) improves survival in muscle-invasive urothelial cancer (MIUC), yet pathological complete response (pCR) is achieved in a minority of patients. Relative dose intensity (RDI) is a potentially modifiable determinant of chemotherapy efficacy, but its impact during NAC in MIUC remains unexplored.
methodsThis multicenter retrospective study included patients with MIUC treated with cisplatin-gemcitabine NAC followed by radical cystectomy. Relative dose intensity was calculated from original administration records and categorized as ≥85% vs <85%. The primary endpoint was pCR (ypT0N0M0). Secondary endpoints included overall survival (OS) and event-free survival (EFS).
resultsA total of 330 patients were included; 66% maintained RDI ≥ 85%. Overall pCR rate was 25.2%. Patients with RDI ≥ 85% achieved higher pCR rates compared with those with RDI < 85% (29.7% vs 16.2%; P = .008). Relative dose intensity ≥ 85% remained independently associated with pCR in multivariable analysis (odds ratio = 2.10; P = .032). Preserved RDI was also associated with improved EFS (hazard ratio [HR] = 0.65; P = .039) and OS (HR = 0.53; P = .026) at univariate analysis. Achievement of pCR was strongly associated with superior EFS (HR = 0.23; P < .001) and OS (HR = 0.35; P = .009).
conclusionPreservation of cisplatin RDI ≥ 85% during NAC is independently correlated with higher pCR rates and associated to a better survival trend in MIUC. Optimization of chemotherapy delivery represents a clinically actionable strategy to enhance neoadjuvant efficacy.
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