Department of Urology, Medstar Georgetown University Hospital, Washington, DC, USA.
Department of Urology, Medstar Washington Hospital Center, Washington, DC, USA.
Investig Clin Urol. 2020 Jul;61(4):390-396. doi: 10.4111/icu.2020.61.4.390. Epub 2020 May 26.
Cisplatin-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) is standard of care for muscle-invasive bladder cancer (MIBC). However, NAC is used in less than 20% of patients with MIBC. Our goal is to investigate factors that contribute to underutilization NAC to facilitate more routine incorporation into clinical practice.
We identified 5,915 patients diagnosed with cT2-T3N0M0 MIBC who underwent RC between 2004 and 2014 from the National Cancer Database. Univariate and multivariable models were created to identify variables associated with NAC utilization.
Only 18.8% of patients received NAC during the study period. On univariate analyses, NAC utilization was more likely at academic hospitals, US South and Midwest (p<0.05). Higher Charlson score was associated with decrease use of NAC (p<0.05). On multivariate analysis, treatment in academic hospitals (odds ratio [OR], 1.367; 95% confidence interval [CI], 1.186-1.576), in the Midwest (OR, 1.538; 95% CI, 1.268-1.977) and South (OR, 1.424; 95% CI, 1.139-1.781) were independently associated with NAC utilization. Older age (75 to 84 years old; OR, 0.532; 95% CI, 0.427-0.664) and higher Charlson score (OR, 0.607; 95% CI, 0.439-0.839) were associated with decreased NAC utilization. Sixty-eight percent of patients did not receive NAC because it was not planned and only 2.5% of patients had contraindications for NAC treatment.
Our study demonstrates that NAC is underutilized. Decreased utilization of NAC was associated with older patients and higher Charlson score. This underutilization may be related to practice patterns as very few patients have true contraindications.
顺铂为基础的新辅助化疗（NAC）后行根治性膀胱切除术（RC）是肌层浸润性膀胱癌（MIBC）的标准治疗方法。然而，只有不到 20%的 MIBC 患者接受 NAC。我们的目标是研究导致 NAC 利用率低的因素，以促进更常规地将其纳入临床实践。
我们从国家癌症数据库中确定了 5915 例在 2004 年至 2014 年间接受 RC 治疗的 cT2-T3N0M0 MIBC 患者。采用单变量和多变量模型来确定与 NAC 利用相关的变量。
在研究期间，只有 18.8%的患者接受了 NAC。在单变量分析中，在学术医院、美国南部和中西部地区，NAC 的使用率更高（p<0.05）。较高的 Charlson 评分与 NAC 使用率降低相关（p<0.05）。多变量分析显示，在学术医院治疗（比值比[OR]，1.367；95%置信区间[CI]，1.186-1.576）、在中西部地区（OR，1.538；95%CI，1.268-1.977）和南部地区（OR，1.424；95%CI，1.139-1.781）与 NAC 的使用独立相关。年龄较大（75-84 岁；OR，0.532；95%CI，0.427-0.664）和 Charlson 评分较高（OR，0.607；95%CI，0.439-0.839）与 NAC 使用率降低相关。68%的患者未接受 NAC，因为未计划进行 NAC，只有 2.5%的患者有 NAC 治疗的禁忌证。
我们的研究表明 NAC 的利用率较低。NAC 利用率降低与老年患者和较高的 Charlson 评分相关。这种利用率低可能与实践模式有关，因为很少有患者有真正的禁忌证。
