Pretreatment C-reactive protein level predicts the response to neoadjuvant chemotherapy of muscle-invasive bladder cancer

ABSTRACT Introduction: There is no established predictor of the neoadjuvant chemotherapy (NAC) response in patients with muscle-invasive bladder cancer (MIBC) treated via radical cystectomy (RC). We assessed the predictive utility of the pretreatment C-reactive protein (CRP) level in terms of the response to NAC in patients with MIBC treated with RC. Patients and Methods: This retrospective study enrolled patients with MIBC treated via RC following NAC at Nagoya University Hospital and affiliated hospitals from January 2004 to December 2020. An elevated CRP was defined as a CRP level ≥1 mg/dL. The association between the response to NAC and the pretreatment CRP level was investigated. Results: We retrospectively identified 192 patients of whom 101 (52.6%) were NAC nonresponders (pathological ≥T2 or node-positive). Nonresponders exhibited poorer 5-year disease-free survival (DFS) (82.5% vs. 42.7%, P < 0.01) and overall survival (OS) (95.3% vs. 48.8%, P < 0.01) than responders. Thirty patients (15.6%) showed elevated CRP levels that correlated with poorer 5 year DFS (66.7% vs. 33.0%, P < 0.01) and OS (74.6% vs. 48.3%, P < 0.01) than others. In multivariate analyses, an elevated CRP level was significantly associated with poorer 5-year DFS [hazard ratio (HR) 3.35, 95% confidence interval (CI) 1.88–5.97, P < 0.01)], OS (HR 2.13, 95% CI 1.13–4.03, P = 0.02), and nonresponder status (odds ratio 3.83, 95% CI 1.4–10.3, P < 0.01). Conclusion: An elevated CRP level may predict NAC nonresponder status and poorer oncological outcome. Upfront RC should be considered for patients with an elevated CRP level.