Symptomatic hydronephrosis associated with muscle invasive bladder cancer (MIBC) necessitates percutaneous nephrostomy (PCN) insertion before neoadjuvant chemotherapy (NAC). This study assesses the impact of PCN presence on standard intended NAC quality, its related complications and outcome after radical cystectomy (RC). The study comprises a retrospective, multicenter cohort of 193 consecutive RCs performed between 2016 and 2019. Eighty (42%) of these patients received NAC and were divided in 2 comparison groups by presence (n = 26; 33%) or absence (n = 54; 67%) of PCN. Endpoints included completion of adequate NAC treatment (cisplatin-based chemotherapy for at least 4 courses), complications during NAC, post-RC complications and hospital stay. Overall, patients with PCN (45/193; 23%) featured a higher referral rate to NAC (58% vs. 36%, = .01), worse glomerular filtration rates ( < .001) and more adverse events ( = .04), in comparison to non-PCN patients. In the NAC cohort, PCN patients had less adequate treatment rates (54% vs. 85%, = .005), and more infections (35% vs, 7%; = .008) and hospitalizations (58% vs. 13%; < .001) during chemotherapy. Post-RC outcome was similar for both comparison groups. PCN was an independent risk factor for inadequate NAC (OR = 3.9, = .04), and infections (OR = 11.3, = .01) and hospitalizations (OR = 7.5, = .004) during NAC. PCN in MIBC patients is a significant risk factor for inadequate NAC and adverse events during treatment. This finding may quire the rationale of NAC, potentially leading to consideration of NAC avoidance and upfront RC in PCN patients. Further survival studies with long follow-up are needed for elucidating this issue.

中文翻译：

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评估经皮肾造口术对肌层浸润性膀胱癌患者新辅助治疗质量的影响

与肌层浸润性膀胱癌（MIBC）相关的症状性肾积水需要在新辅助化疗（NAC）之前进行经皮肾造口术（PCN）插入。本研究评估了 PCN 的存在对标准预期 NAC 质量、其相关并发症和根治性膀胱切除术 (RC) 后结果的影响。该研究包括 2016 年至 2019 年间进行的 193 例连续 RC 回顾性多中心队列。其中 80 名 (42%) 患者接受了 NAC，并根据存在 (n = 26; 33%) 或不存在 (n = 54；67%）的多氯化萘。终点包括完成足够的 NAC 治疗（基于顺铂的化疗至少 4 个疗程）、NAC 期间的并发症、RC 后并发症和住院时间。总体而言，PCN 患者 (45/193; 23%) 的 NAC 转诊率较高（58% vs. 36%，= .01），肾小球滤过率较差 ( < .001) 且不良事件较多 ( = .04 ），与非 PCN 患者相比。在 NAC 队列中，PCN 患者的治疗率较低（54% vs. 85%，= .005），感染率较高（35% vs. 7%；= .008）和住院治疗（58% vs. 13%；= .008）。 < .001) 化疗期间。两个对照组的 RC 后结果相似。 PCN 是 NAC 不足 (OR = 3.9, = .04)、NAC 期间感染 (OR = 11.3, = .01) 和住院 (OR = 7.5, = .004) 的独立危险因素。 MIBC 患者中的 PCN 是治疗期间 NAC 不足和不良事件的重要危险因素。这一发现可能会质疑 NAC 的基本原理，并可能导致 PCN 患者考虑避免 NAC 和预先 RC。需要进一步进行长期随访的生存研究来阐明这个问题。