A 65-year-old man with T2 muscle-invasive bladder cancer (MIBC) is considered for radical cystectomy. Neoadjuvant chemotherapy with cisplatin-based regimen (MVAC or gemcitabine-cisplatin) is offered. The absolute survival benefit of neoadjuvant chemotherapy in MIBC is approximately:

• A 3-5% at 5 years
• B 15-20% at 5 years
• C 25-30% at 5 years
• D 8-10% at 5 years ✓

Explanation

Multiple randomised trials and a meta-analysis (Advanced Bladder Cancer Collaboration) have shown that neoadjuvant cisplatin-based chemotherapy before radical cystectomy for MIBC provides an absolute overall survival benefit of approximately 8-10% at 5 years (from ~45% to ~55%). This benefit is consistent across trials despite individual studies sometimes underpowered. Neoadjuvant chemotherapy also achieves pathological complete response (pT0) in 25-35% of patients, which strongly predicts survival.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.