Trends in utilization of neoadjuvant and adjuvant chemotherapy for muscle invasive bladder cancer

Coleman McFerrin; Facundo Davaro; Allison May; Syed Raza; Sameer Siddiqui; Zachary Hamilton

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자료유형: 학술저널

저자정보: Coleman McFerrin (Saint Louis University) Facundo Davaro (Saint Louis University) Allison May (Saint Louis University) Syed Raza (Saint Louis University) Sameer Siddiqui (Saint Louis University) Zachary Hamilton (Saint Louis University)

저널정보: 대한비뇨기과학회 Investigative and Clinical Urology Investigative and Clinical Urology Vol.61 No.6

발행연도: 2020.1

수록면: 565 - 572 (8page)

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Purpose: Previous studies have noted increased utilization of perioperative chemotherapy over time. The goal of this study was to determine trends in perioperative chemotherapy use within a contemporary population. Materials and Methods: The National Cancer Database was queried for patients diagnosed with cT2-4N0M0 urothelial muscle invasive bladder cancer from 2011 to 2015 and underwent subsequent radical cystectomy. We retrospectively analyzed factors associated with perioperative chemotherapy and evaluated overall treatment trends in the use of neoadjuvant and adjuvant chemotherapy. Linear regression, logistic regression, Cox regression, and Kaplan–Meier analysis were performed. Results: In total, 7,101 patients met inclusion criteria for analysis. The use of perioperative chemotherapy increased from 46.4% in 2011 to 57.2% in 2015 (p=0.003). Neoadjuvant chemotherapy use increased from 22.9% to 32.3% (p=0.007) over the time period analyzed, while adjuvant chemotherapy use experienced no significant change (23.5% to 24.9%, p=0.182). Logistic regression demonstrated that increased age and Charlson Comorbidity Index were predictors of not receiving chemotherapy (p<0.05), while those with increasing T stage, income above $48,000, and insurance other than Medicaid or Medicare were more likely to receive perioperative chemotherapy (p<0.05). Kaplan–Meier analysis revealed patients receiving neoadjuvant chemotherapy had the best 5-year overall survival at 48.3% compared to adjuvant chemotherapy (42.6%) or no chemotherapy (37.8%) (p<0.001). Conclusions: The increasing use of perioperative chemotherapy noted in prior studies has continued through 2015. Neoadjuvant chemotherapy appears to drive this increase while adjuvant chemotherapy utilization remains unchanged. Clinical and socioeconomic factors affect utilization of perioperative chemotherapy.

#Drug therapy #Neoplasm invasiveness #Survival #Urinary bladder neoplasms

참고문헌 (24)

참고문헌 신청

DeGeorge KC / 2017 / Bladder cancer : diagnosis and treatment / Am Fam Physician 96:507~514

Pradère B / 2017 / Peri-operative chemotherapy for muscle-invasive bladder cancer : status-quo in 2017 / Transl Androl Urol 6:1049~1059

Sternberg CN / 2013 / ICUD-EAU International Consultation on Bladder Cancer 2012: chemotherapy for urothelial carcinoma-neoadjuvant and adjuvant settings / Eur Urol 63:58~66

Grossman HB / 2003 / Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer / N Engl J Med 349:859~866

Porter MP / 2011 / Patterns of use of systemic chemotherapy for Medicare beneficiaries with urothelial bladder cancer / Urol Oncol 29:252~258

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