Combined and individual effects of neoadjuvant chemotherapy and lymph node dissection on survival in non–muscle-invasive bladder cancer undergoing radical cystectomy

In NMIBC patients undergoing RP, LND represented the primary driver of survival benefit, whereas NAC alone was not independently associated with improved outcomes. The combination of NAC and LND conferred an additional, incremental advantage over either modality alone, with the magnitude of benefit varying across patient characteristics. In the T1 high-grade urothelial carcinoma subgroup, both NAC and LND were associated with improved survival, with LND providing the dominant effect and the combined strategy yielding the greatest benefit, with advantages over no treatment observed across nearly all subgroups.