Jonas Schiffmann1, Maxine Sun2, Giorgio Gandaglia3, Zhe Tian2, Ioana Popa2, Alessandro Larcher4, Malek Meskawi2, Alberto Briganti5, Michael McCormack6, Shahrokh F Shariat7, Francesco Montorsi5, Markus Graefen8, Fred Saad9, Pierre I Karakiewicz10. 1. Martini-Clinic, Prostate Cancer Centre, University Medical Centre Hamburg-Eppendorf, Germany;; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada; 2. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada; 3. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada;; Department of Urology, Vita-Salute, San Raffaele University, Milan, Italy; 4. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada;; Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; 5. Department of Urology, Vita-Salute, San Raffaele University, Milan, Italy; 6. Department of Surgery, University of Montreal, Montreal, QC, Canada; 7. Department of Urology, Medical University of Vienna, Vienna, Austria; 8. Martini-Clinic, Prostate Cancer Centre, University Medical Centre Hamburg-Eppendorf, Germany; 9. Department of Urology, University of Montreal, Montreal, QC, Canada. 10. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada;; Department of Urology, University of Montreal, Montreal, QC, Canada.
Abstract
INTRODUCTION: We aimed to assess contemporary rates of neoadjuvant chemotherapy (NC) use. METHODS: We relied on the Surveillance, Epidemiology and End Results (SEER)-Medicare database for non-metastatic, muscle-invasive (T2-T4a) urothelial carcinoma of the urinary bladder (UCUB) patients who underwent radical cystectomy (RC) between 1991 and 2009. Multivariable logistic regression analyses tested predictors of NC use, such as: T-stage, N-stage, year of diagnosis, age at diagnosis, gender, race, use of radiotherapy (RT), marital status, urban status, socioeconomic status, tumour grade, and Charlson comorbidity index (CCI). RESULTS: Overall, 5207 patients treated with RC were identified. Of those, 332 (6.4%) received NC. The rate of NC increased over time from 6.1% (1991) to 15.0% (2009) (p<0.001). In multivariable analyses, year of diagnosis (odds ratio [OR]: 4.7; p<0.001), lower T-stage (T3 vs. T2: OR: 0.7; p=0.003), married status (OR: 1.5; p=0.006), and younger age at diagnosis (≥80 vs. 66-69: OR: 0.6; p=0.006) were associated with a higher odds of NC; all represented independent predictors of NC use. Neither race nor CCI demonstrated statistical significance. CONCLUSIONS: We reported lower than anticipated overall (6.4%) use of NC. Nonetheless, the rate increased from 6.1% (1991) to 15.0% (2009). Older and unmarried individuals were less likely to receive NC. NC rates were higher in T2 UCUB patients. Some of the observed discrepancies, such as lower use in unmarried individuals, may require correction. Better adherence to guidelines should be encouraged and implemented, especially based on the confirmed benefits of NC according to randomized, controlled trials. The study is limited by a retrospective design and limited variables.
INTRODUCTION: We aimed to assess contemporary rates of neoadjuvant chemotherapy (NC) use. METHODS: We relied on the Surveillance, Epidemiology and End Results (SEER)-Medicare database for non-metastatic, muscle-invasive (T2-T4a) urothelial carcinoma of the urinary bladder (UCUB) patients who underwent radical cystectomy (RC) between 1991 and 2009. Multivariable logistic regression analyses tested predictors of NC use, such as: T-stage, N-stage, year of diagnosis, age at diagnosis, gender, race, use of radiotherapy (RT), marital status, urban status, socioeconomic status, tumour grade, and Charlson comorbidity index (CCI). RESULTS: Overall, 5207 patients treated with RC were identified. Of those, 332 (6.4%) received NC. The rate of NC increased over time from 6.1% (1991) to 15.0% (2009) (p<0.001). In multivariable analyses, year of diagnosis (odds ratio [OR]: 4.7; p<0.001), lower T-stage (T3 vs. T2: OR: 0.7; p=0.003), married status (OR: 1.5; p=0.006), and younger age at diagnosis (≥80 vs. 66-69: OR: 0.6; p=0.006) were associated with a higher odds of NC; all represented independent predictors of NC use. Neither race nor CCI demonstrated statistical significance. CONCLUSIONS: We reported lower than anticipated overall (6.4%) use of NC. Nonetheless, the rate increased from 6.1% (1991) to 15.0% (2009). Older and unmarried individuals were less likely to receive NC. NC rates were higher in T2 UCUB patients. Some of the observed discrepancies, such as lower use in unmarried individuals, may require correction. Better adherence to guidelines should be encouraged and implemented, especially based on the confirmed benefits of NC according to randomized, controlled trials. The study is limited by a retrospective design and limited variables.
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