Age related trends in the utilization of neoadjuvant chemotherapy for muscle invasive bladder cancer

•Use of neoadjuvant chemotherapy for muscle invasive bladder cancer is increasing.•Use of neoadjuvant chemotherapy decreases with increasing age.•Neoadjuvant chemotherapy confers pathologic downstaging, regardless of age.•Neoadjuvant chemotherapy is not associated with increased 30-day readmission. The current standard of care for muscle invasive bladder cancer (MIBC) is neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC). Previous research has shown under-utilization of NAC for treatment of MIBC, especially among the elderly. Our aim was to stratify NAC use by decade of life and analyze trends in use over time along with recording pathologic downstaging and perioperative outcomes. The National Cancer Database was queried for patients with cT2-4NanyM0 MIBC treated with RC from 2010 to 2016 with urothelial carcinoma. Nineteen thousand nine hundred fifty seven patients met criteria for analysis. We retrospectively analyzed trends in use of NAC, readmission rate, mortality rate, and pathologic downstaging with NAC all stratified by decade of life. Of the 19,957 patients treated with RC for MIBC, only 30.9% underwent NAC. There was a statistically significant increase in NAC use across all age groups from 2010 to 2016. Receipt of NAC was associated with decreased age on univariate analysis (P < 0.001) and on logistic regression (OR: 0.617 for age 70–79, OR: 0.221 for age ≥80 vs. age