Clinical and pathological predictors of early recurrence after neoadjuvant cisplatin gemcitabine in muscle invasive bladder cancer in the RealBLADDER study

Neoadjuvant cisplatin-based chemotherapy (NAC) confers a survival benefit in muscle-invasive bladder cancer (MIBC), however a relevant proportion of patients experience early disease recurrence following radical cystectomy. We conducted a multicenter observational study to evaluate clinical, pathological, and laboratory factors associated with early recurrence defined as disease-free survival [DFS] ≤ 12 months in patients with MIBC treated with neoadjuvant cisplatin plus gemcitabine followed by radical cystectomy. Early recurrence was significantly associated with aggressive pathological features, including higher ypT stage, nodal involvement, lymphovascular invasion, and lower rates of pathological complete response. Patients experiencing early recurrence predominantly presented with systemic dissemination and had significantly shorter DFS and overall survival (OS). Variant histology and the presence of post-treatment lymphovascular invasion were independently associated with early recurrence. Early recurrence after NAC identifies a subgroup of patients with aggressive clinicopathological features and poorer oncological outcomes, highlighting the need for improved postoperative risk stratification and novel perioperative treatment strategies.