我们的目的是评估肌层浸润性膀胱癌 (MIBC) 患者新辅助化疗 (NAC) 的使用情况以及缺乏 NAC 接受的病因。纳入了在同一机构（2005-2021 年）接受根治性膀胱切除术的诊断为 MIBC 的患者。患者根据接受 NAC 的情况进行分类，未接受 NAC 的原因分为资格因素和选择性因素。使用单变量和多变量 Cox 比例风险回归模型分析总生存率，并使用 Kaplan-Meier 曲线建模。 纳入了 380 名 MIBC 患者； 154 人（40.5%）接受了 NAC。由于肾功能障碍（16.6%）、临床禁忌症（4.7%）、挽救情况（2.1%）和组织学（5.3%；总 N=109），患者不适合接受 NAC。在 271 名符合资格的人 (71.3%) 中，利用率从早期 (2005-2016 年) 到近期 (2016-2021 年) 有所增加（符合 NAC 资格的人为 34.2% 增至 85.7%，P < .001；22.8% 与 2016 年的 67.1%所有 MIBC，P < .001）。在 271 名符合 NAC 资格的患者中，不接受 NAC 的选择性因素包括患者症状 (7.8%)、疾病进展担忧 (7.0%)、患者偏好/拒绝 (20.3%) 和医疗服务提供者的判断力 (8.1%)。值得注意的是，近年来患者偏好/拒绝的比例从 33.6% 下降至 3.4% (P < .001)。在多变量分析中，由于肾功能不全（HR 2.18，P = .002）、临床禁忌症（HR 2.62，P = .01）和选择性因素（HR 1.88，P = .01）而导致 NAC 利用率不足与较差的情况相关。总生存率。NAC 的利用率随着时间的推移而增加，近年来，85.7% 的符合资格的 MIBC 患者接受了 NAC。肾功能障碍、患者偏好和临床禁忌症是缺乏 NAC 的主要原因。近年来拒绝 NAC 的患者越来越少，导致 NAC 使用的潜在上限。

We aimed to assess utilization of neoadjuvant chemotherapy (NAC) and etiologies for lack of NAC receipt among patients with muscle-invasive bladder cancer (MIBC).Patients diagnosed with MIBC undergoing radical cystectomy at a single institution (2005-2021) were included. Patients were categorized by receipt of NAC, and reasons for no NAC were categorized into eligibility and elective factors. Overall survival was analyzed using univariable and multivariable Cox proportional hazards regression models and modeled with Kaplan-Meier curves.Three hundred eightypatients with MIBC were included; 154 (40.5%) received NAC. Patients were not candidates for NAC due to renal dysfunction (16.6%), clinical contraindications (4.7%), salvage setting (2.1%), and histology (5.3%; total N=109). Among 271 (71.3%) who were eligible, utilization increased from early (2005-2016) to recent (2016-2021) time periods (34.2% to 85.7% among NAC-eligible, P < .001; 22.8% vs 67.1% among all MIBC, P < .001). Elective factors for not receiving NAC included patient symptoms (7.8%), disease progression concern (7.0%), patient preference/refusal (20.3%) and provider discretion (8.1%) among 271 NAC-eligible patients. Notably, patient preference/refusal decreased from 33.6% to 3.4% in recent years (P < .001). On multivariable analysis, lack of NAC utilization due to renal dysfunction (HR 2.18, P = .002), clinical contraindications (HR 2.62, P = .01), and elective factors (HR 1.88, P = .01) were associated with worse overall survival.NAC utilization increased over time with 85.7% of eligible patients with MIBC receiving NAC in recent years. Renal dysfunction, patient preference, and clinical contraindications were primary etiologies for lack of NAC. Fewer patients refused NAC in recent years leading to a potential ceiling for NAC utilization.