Stanley A Yap1, Ann Brunson2, Neil Pugashetti3, Rosemary D Cress4, Theresa H M Keegan2, Ralph deVere White5, Ted Wun6. 1. Department of Urology, University of California Davis, Sacramento, CA; University of California Davis Comprehensive Cancer Center, Sacramento, CA; Division of Urology, Department of Surgery, VA Northern California Health Care System, Sacramento, CA. Electronic address: syap@ucdavis.edu. 2. Division of Hematology Oncology, Center for Oncology and Hematology Outcomes Research and Training (COHORT), UC Davis School of Medicine, Sacramento, CA. 3. Department of Urology, University of California Davis, Sacramento, CA. 4. University of California Davis Comprehensive Cancer Center, Sacramento, CA; Department of Public Health Sciences, School of Medicine, University of California Davis, Davis, CA; Public Health Institute, Cancer Registry of Greater California, Sacramento, CA. 5. Department of Urology, University of California Davis, Sacramento, CA; University of California Davis Comprehensive Cancer Center, Sacramento, CA. 6. University of California Davis Comprehensive Cancer Center, Sacramento, CA; Division of Hematology Oncology, Center for Oncology and Hematology Outcomes Research and Training (COHORT), UC Davis School of Medicine, Sacramento, CA.
Abstract
OBJECTIVES: To demonstrate patterns of uptake and impact on recurrence of intravesical chemotherapy (IC) immediately following transurethral resection of bladder tumor (TURBT) for low-grade non-muscle-invasive bladder cancer (NMIBC) at a population level. METHODS: Incident cases of low-grade (LG) Ta or T1 NMIBC from 2005 to 2012 were identified from the California Cancer Registry. We determined rates of IC utilization following TURBT. Multivariable logistic regression models were utilized to assess predictors of IC utilization. Multivariable Cox proportional hazards regression was used to assess the association of IC utilization with recurrence-free survival, bladder cancer-specific survival, and overall survival. RESULTS: Ten thousand thirty-one patients with LG NMIBC diagnosed in California between 2005 and 2012. The overall rate of IC utilization was 5.1%, and increased from 1.7% (2005-2006) to 9.6% (2011-2012). More recent year of diagnosis (Odds ratio 1.74, confidence interval 1.60-1.90 for 2-year increments) was associated with an increased likelihood of undergoing immediate postoperative IC. The cumulative incidence of recurrence at 24 months for patients who received IC was 25.2% compared to 30.2% among those who did not receive IC. Use of IC was significantly associated with improved recurrence-free survival (Hazards ratio 0.82, confidence interval 0.70-0.97). CONCLUSION: Utilization of IC for LG NMIBC remains dismally low, with less than 10% of patients receiving this standard of care. Low utilization is associated with increased rates of recurrence. We demonstrate a major shortcoming in quality of care with potential widespread impact on outcomes and cost of care.
OBJECTIVES: To demonstrate patterns of uptake and impact on recurrence of intravesical chemotherapy (IC) immediately following transurethral resection of bladder tumor (TURBT) for low-grade non-muscle-invasive bladder cancer (NMIBC) at a population level. METHODS: Incident cases of low-grade (LG) Ta or T1 NMIBC from 2005 to 2012 were identified from the California Cancer Registry. We determined rates of IC utilization following TURBT. Multivariable logistic regression models were utilized to assess predictors of IC utilization. Multivariable Cox proportional hazards regression was used to assess the association of IC utilization with recurrence-free survival, bladder cancer-specific survival, and overall survival. RESULTS: Ten thousand thirty-one patients with LG NMIBC diagnosed in California between 2005 and 2012. The overall rate of IC utilization was 5.1%, and increased from 1.7% (2005-2006) to 9.6% (2011-2012). More recent year of diagnosis (Odds ratio 1.74, confidence interval 1.60-1.90 for 2-year increments) was associated with an increased likelihood of undergoing immediate postoperative IC. The cumulative incidence of recurrence at 24 months for patients who received IC was 25.2% compared to 30.2% among those who did not receive IC. Use of IC was significantly associated with improved recurrence-free survival (Hazards ratio 0.82, confidence interval 0.70-0.97). CONCLUSION: Utilization of IC for LG NMIBC remains dismally low, with less than 10% of patients receiving this standard of care. Low utilization is associated with increased rates of recurrence. We demonstrate a major shortcoming in quality of care with potential widespread impact on outcomes and cost of care.
Authors: K Kent Chevli; Neal D Shore; Andrew Trainer; Angela B Smith; Daniel Saltzstein; Yaron Ehrlich; Jay D Raman; Boris Friedman; Richard D'Anna; David Morris; Brian Hu; Mark Tyson; Alexander Sankin; Max Kates; Jennifer Linehan; Douglas Scherr; Steven Kester; Michael Verni; Karim Chamie; Lawrence Karsh; Arnold Cinman; Andrew Meads; Soumi Lahiri; Madlen Malinowski; Nimrod Gabai; Sunil Raju; Mark Schoenberg; Elyse Seltzer; William C Huang Journal: J Urol Date: 2021-08-26 Impact factor: 7.450