FIG. 10:  Achieving pT0 is important for outcome, as shown in SWOG 8710^[2] and in multiple subsequent study reports.  In patients randomized to surgery alone in SWOG 8710, 15% achieved pT0 because all of the tumor was resected before going to cystectomy.  In patients randomized to neoadjuvant MVAC plus cystectomy, the pT0 rate was more than doubled to 38% (highly statistically significant, P=0.001). 

Mortality risk in the patients randomized to surgery was 33% higher than those randomized to neoadjuvant chemotherapy; the disease-specific risk for those randomized to surgery was 66% greater than for those randomized to neoadjuvant chemotherapy.