Trends in the utilization of neoadjuvant chemotherapy in muscle-invasive bladder cancer: results from the National Cancer Database.

OBJECTIVE: To evaluate variation in neoadjuvant chemotherapy (NAC) use among patients with ≥ clinical T2 (cT2) bladder cancer and determine changes in staging at radical cystectomy (RC) associated with therapy.
METHODS: Using the National Cancer Database (NCDB), we identified all patients diagnosed with organ-confined, muscle-invasive (cT2+) urothelial carcinoma of the bladder between 2006 and 2010 who underwent RC. Univariate and multivariate analyses were performed examining demographic, clinical, and hospital factors influencing the delivery of NAC. These included age, gender, race, income, geographic location, type of treating hospital, clinical stage, and patient comorbidities.
RESULTS: A total of 5692 patients met our inclusion criteria, 962 (16.9%) of whom received NAC. A multivariable logistic regression model revealed several factors that negatively influenced receipt of NAC: increasing age, lower patient income, and treatment at a nonacademic institution (P <.01). Higher clinical stage and fewer comorbid conditions were associated with higher likelihood of receiving NAC (P <.01). The overall use of NAC increased from 7.6% in 2006 to 20.9% in 2010 (P <.01). Those receiving NAC were significantly more likely to be downstaged at RC (31.2% vs 7.6%, P <.01), with 10.6% achieving complete pathologic downstaging.
CONCLUSION: Although the use of NAC for organ-confined muscle invasive bladder cancer remains low, it is increasing over time. Patients receiving NAC are more likely to be downstaged and achieve complete pathologic downstaging. However, there is considerable variation in treatment patterns based on both clinical and nonclinical factors.