Department of Urology, University of Kansas Health System, Kansas City, KS, United States.
Department of Population, Health University of Kansas Health System, Kansas City, KS, United States.
Int Braz J Urol. 2021 Jul-Aug;47(4):803-818. doi: 10.1590/S1677-5538.IBJU.2020.0594.
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.
肌层浸润性膀胱癌（MIBC）的基于指南的最佳实践治疗包括新辅助化疗后行根治性膀胱切除术（NACRC）。先前的研究表明，少数患者接受 NACRC，而年龄较大和肾功能是不接受 NACRC 的驱动因素。本研究调查了在合并症较低的 MIBC 患者中，最有可能成为 NACRC 候选者的患者中，不接受 NACRC 的治疗率和相关因素。
对 2006 年至 2015 年美国国家癌症数据库中Charlson 合并症指数（CCI）为零的 MIBC 患者进行回顾性分析。还分析了 CCI 较高患者中 NACRC 治疗趋势。
符合纳入标准的 MIBC 患者为 15561 例。9 个月内诊断后，有 1507 例（9.7%）接受 NACRC 治疗。NACRC 随时间增加（2015 年为 15.0%，而 2006 年为 3.6%）。女性、cT3 或 cT4 癌症、较晚的诊断年份和学术机构治疗中，NACRC 较高。黑人的利用率较低，NACRC 随年龄和 CCI 的增加而降低。在年龄最低四分位数（23-62 岁）、CCI 为 0 的肌层浸润性膀胱癌患者中，只有 16.9%接受 NACRC。
尽管利用率在增加，但即使在最有可能成为候选者的人群中，接受 NACRC 的比例仍然较低。应进一步研究阐明接受 NACRC 的障碍。
