Nayan Madhur, Bhindi Bimal, Yu Julie L, Mamdani Muhammad, Fleshner Neil E, Hermanns Thomas, Chung Peter, Milosevic Michael, Bristow Robert, Warde Padraig, Hamilton Robert J, Finelli Antonio, Jewett Michael A S, Zlotta Alexandre R, Sridhar Srikala S, Kulkarni Girish S
Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada;
Department of Anesthesia, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada;
Can Urol Assoc J. 2016 Jan-Feb;10(1-2):25-30. doi: 10.5489/cuaj.3315.
While level 1 evidence supports the use of neoadjuvant chemotherapy (NAC) for patients with muscle-invasive bladder cancer (MIBC), its uptake has been underwhelming, even in academic centres. Our aim was to determine if the initiation of a multidisciplinary bladder cancer clinic (MDBCC) in 2008 at our institution, where patients are assessed simultaneously by bladder cancer-focused urologists and radiation oncologists with easy access to a medical oncologist, was associated with an increased use of NAC.
Patients with MIBC initiating treatment between July 2000 and June 2013 were identified and classified by academic year (July 1 to June 30). Time-series analyses using interventional autoregressive integrated moving average (ARIMA) models with ramp intervention functions were then conducted. A sensitivity analysis was performed on clinical N0 patients.
The cohort included 278 patients: 168 from 2000-2007 and 110 from 2008-2012 (academic years). Forty-two (15.1%) patients received NAC and 74 (26.6%) received adjuvant chemotherapy (AC). Overall the proportion of patients receiving NAC increased from 7.7% before the MDBCC to 47.6% in 2012 (Interventional ARIMA p=0.036). The results were similar when restricting to cN0 patients (p<0.001). NAC use gradually increased over time regardless of MDBCC attendance, although the proportion of patients receiving NAC appears to have risen more sharply among MDBCC attendees.
At our institution, the initiation of the MDBCC was temporally associated with increased use of NAC. In addition to multidisciplinary collaboration, having a critical mass of NAC physician advocates and support from institutional leaders are essential to the uptake of NAC.
虽然一级证据支持对肌层浸润性膀胱癌（MIBC）患者使用新辅助化疗（NAC），但其应用情况并不理想，即便在学术中心亦是如此。我们的目的是确定2008年在我们机构启动的多学科膀胱癌诊所（MDBCC）是否与NAC使用增加有关，在该诊所，专注于膀胱癌的泌尿科医生和放射肿瘤学家会同时对患者进行评估，且患者可方便地接触到医学肿瘤学家。
确定2000年7月至2013年6月期间开始治疗的MIBC患者，并按学年（7月1日至6月30日）进行分类。然后使用带有斜坡干预函数的干预自回归积分移动平均（ARIMA）模型进行时间序列分析。对临床N0患者进行了敏感性分析。
该队列包括278例患者：2000 - 2007年有168例，2008 - 2012年（学年）有110例。42例（15.1%）患者接受了NAC，74例（26.6%）接受了辅助化疗（AC）。总体而言，接受NAC的患者比例从MDBCC成立前的7.7%增至2012年的47.6%（干预ARIMA p = 0.036）。限制为cN0患者时结果相似（p < 0.001）。无论是否参加MDBCC，NAC的使用随时间逐渐增加，尽管在参加MDBCC的患者中接受NAC的患者比例似乎上升得更为明显。
在我们机构，MDBCC的启动在时间上与NAC使用增加相关。除了多学科协作外，拥有足够数量的NAC医生支持者以及机构领导的支持对于NAC的应用至关重要。
