Factors associated with utilization of neoadjuvant chemotherapy in charlson comorbidity zero non-metastatic muscle-invasive bladder cancer patients

Guideline-based best practice treatment for muscle invasive bladder cancer (MIBC) involves neoadjuvant chemotherapy followed by radical cystectomy (NACRC). Prior studies have shown that a minority of patients receive NACRC and older age and renal function are drivers of non-receipt of NACRC. This st...

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Veröffentlicht in:International Brazilian Journal of Urology Jg. 47; H. 4; S. 803 - 818
Hauptverfasser: Au, Daniel, Lee, Eugene K., Popoola, Taiye O., Parker, William P., Onge, Jarron M. Saint, Ellis, Shellie D.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: Brazil Sociedade Brasileira de Urologia 01.07.2021
Schlagworte:
Adult
Aged
Comorbidity
Cystectomy
Female
Humans
Middle Aged
Muscles
Neoadjuvant Therapy
Neoplasm Invasiveness
Original
Retrospective Studies
United States
Urinary Bladder Neoplasm
Urinary Bladder Neoplasms - drug therapy
Urinary Bladder Neoplasms - surgery
Young Adult
United States
Neoadjuvant Therapy
Cystectomy
Urinary Bladder Neoplasms
ISSN:1677-5538, 1677-6119, 1677-6119
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Zusammenfassung:Guideline-based best practice treatment for muscle invasive bladder cancer (MIBC) involves neoadjuvant chemotherapy followed by radical cystectomy (NACRC). Prior studies have shown that a minority of patients receive NACRC and older age and renal function are drivers of non-receipt of NACRC. This study investigates treatment rates and factors associated with not receiving NACRC in MIBC patients with lower comorbidity status most likely to be candidates for NACRC. Retrospective United States National Cancer Database analysis from 2006 to 2015 of MIBC patients with Charlson comorbidity index (CCI) of zero. Analysis of NACRC treatment trends in higher CCI patients was also performed. 15.561 MIBC patients met inclusion criteria. 1.507 (9.7%) received NACRC within 9 months of diagnosis. NACRC increased over time (15.0% in 2015 compared to 3.6% in 2006). Higher NACRC was noted in females, cT3 or cT4 cancer, later year of diagnosis, and academic facility treatment. Lower utilization was noted for blacks and NACRC decreased with increasing age and CCI. Only 16.9% of patients aged 23-62 in the lowest age quartile with muscle invasive bladder cancer and CCI of 0 received NACRC. Although utilization is increasing, receipt of NACRC remains low even in populations most likely to be candidates. Further study should continue to elucidate barriers to utilization of NACRC.
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CONFLICT OF INTEREST
None declared.
ISSN:1677-5538
1677-6119
1677-6119
DOI:10.1590/s1677-5538.ibju.2020.0594