Ohlmann C H, Kerkmann M, Holtmann L, Gschwend J E, Retz M, de Wit M
Klinik für Urologie, Johanniter Krankenhaus Bonn, Bonn, Deutschland.
MMF GmbH, Münster, Deutschland.
Urologie. 2022 Dec;61(12):1351-1364. doi: 10.1007/s00120-022-01870-z. Epub 2022 Jun 29.
The S3-guideline on bladder cancer recommends radical cystectomy and cisplatin-based perioperative chemotherapy (POC) for muscle-invasive bladder cancer (MIBC). Recommendation for metastatic urothelial cancer (mUC) is cisplatin-based or immuno-oncological (IO) treatment in platinum-ineligible patients (pts) or as 2nd-line therapy.
Aim of the study was to obtain representative data on clinical routine treatment of MIBC and mUC in Germany.
A nationwide survey was performed to obtain data on stage-related patient volume in hospitals and office-based physicians. Based on these results, a representative sample of treatment data was collected retrospectively from pts with MIBC and mUC.
Data from 956 pts (MIBC 576; mUC: 380) were collected. Of the MIBC pts, 49.8% received a systemic therapy (80.4% of them received cisplatin/gemcitabine) and 50.2% were treated with a cystectomy without POC. Significant factors for cystectomy without POC were higher age > 75 years (odds ratio [OR] 4.91, 95% confidence interval [CI] 3.01-8.11, p < 0.001) and platinum-ineligible pts (OR 2.15, 95% CI 1.30-3.59; p = 0.003). Treatment decision without interdisciplinary tumor board was also correlated with no POC (OR 2.43, 95% CI 1.65-3.61, p < 0.001). In mUC platinum-pretreated pts generally receive IO therapy (OR 12.07, 95% CI 6.94-21.82, p < 0.001). Other significant factors are positive PD-L1 status (OR 3.72, 95% CI 1.30-5.71, p < 0.001), higher age > 75 years (OR 2.83, 95% CI 1.43-5.73, p = 0.003) and platinum-ineligible pts (OR 2.57, 95% CI 1.30-5.71, p = 0.007).
The "gold standard" cisplatin/gemcitabine is established in Germany if pts are treated with POC. Nonetheless half of the MIBC pts did not receive a POC, especially if the treatment decision is not discussed in a tumor board. In mUC IO therapy is established as 2nd-line therapy after a platinum-based treatment. Although the guideline recommendations are largely implemented, there is potential for optimization, especially in the establishment of interdisciplinary tumor boards.
膀胱癌S3指南推荐对肌层浸润性膀胱癌（MIBC）行根治性膀胱切除术及以顺铂为基础的围手术期化疗（POC）。对于转移性尿路上皮癌（mUC），推荐在铂类不适用的患者中采用以顺铂为基础的治疗或免疫肿瘤学（IO）治疗，或作为二线治疗。
本研究的目的是获取德国MIBC和mUC临床常规治疗的代表性数据。
进行了一项全国性调查，以获取医院和门诊医生中与分期相关的患者数量数据。基于这些结果，回顾性收集了MIBC和mUC患者的代表性治疗数据样本。
收集了956例患者的数据（MIBC 576例；mUC 380例）。在MIBC患者中，49.8%接受了全身治疗（其中80.4%接受顺铂/吉西他滨治疗），50.2%接受了无POC的膀胱切除术。无POC行膀胱切除术的显著因素包括年龄＞75岁（比值比[OR]4.91，95%置信区间[CI]3.01 - 8.11，p＜0.001）和铂类不适用的患者（OR 2.15，95% CI 1.30 - 3.59；p = 0.
