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Age related trends in the utilization of neoadjuvant chemotherapy for muscle invasive bladder cancer.
Kohut-Jackson, Abigail; Orf, Jeffrey; Barresi, Dominic; Davaro, Facundo; Hamilton, Zachary.
Afiliación
  • Kohut-Jackson A; Division of Urology, Department of Surgery, Saint Louis University, St Louis, MO.
  • Orf J; Division of Urology, Department of Surgery, Saint Louis University, St Louis, MO.
  • Barresi D; Division of Urology, Department of Surgery, Saint Louis University, St Louis, MO.
  • Davaro F; Division of Urology, Department of Surgery, Saint Louis University, St Louis, MO.
  • Hamilton Z; Division of Urology, Department of Surgery, Saint Louis University, St Louis, MO. Electronic address: zachary.hamilton@slucare.ssmhealth.com.
Urol Oncol ; 42(5): 160.e25-160.e31, 2024 May.
Article en En | MEDLINE | ID: mdl-38238117
ABSTRACT

PURPOSE:

The current standard of care for muscle invasive bladder cancer (MIBC) is neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC). Previous research has shown under-utilization of NAC for treatment of MIBC, especially among the elderly. Our aim was to stratify NAC use by decade of life and analyze trends in use over time along with recording pathologic downstaging and perioperative outcomes. MATERIALS AND

METHODS:

The National Cancer Database was queried for patients with cT2-4NanyM0 MIBC treated with RC from 2010 to 2016 with urothelial carcinoma. Nineteen thousand nine hundred fifty seven patients met criteria for analysis. We retrospectively analyzed trends in use of NAC, readmission rate, mortality rate, and pathologic downstaging with NAC all stratified by decade of life.

RESULTS:

Of the 19,957 patients treated with RC for MIBC, only 30.9% underwent NAC. There was a statistically significant increase in NAC use across all age groups from 2010 to 2016. Receipt of NAC was associated with decreased age on univariate analysis (P < 0.001) and on logistic regression (OR 0.617 for age 70-79, OR 0.221 for age ≥80 vs. age <60; P < 0.001). Patients receiving NAC were more likely to exhibit pathologic downstaging at time of RC (OR 3.907; P < 0.001), and this trend held for each age group examined. Among patients receiving NAC, the risk of 30 and 90-day mortality was associated with increasing age; however, age was not associated with 30-day readmission for those receiving NAC.

CONCLUSION:

Rates of NAC use prior to RC have increased among all age groups with the lowest utilization rate among the elderly. NAC use was associated with greater pathologic downstaging in all age groups. These data show a promising trend in the uptake of the gold standard for treatment of MIBC; however, the underlying etiology of differing rates of NAC utilization remains to be determined.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias de la Vejiga Urinaria / Carcinoma de Células Transicionales Límite: Aged / Humans Idioma: En Revista: Urol Oncol Asunto de la revista: NEOPLASIAS / UROLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Macao Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias de la Vejiga Urinaria / Carcinoma de Células Transicionales Límite: Aged / Humans Idioma: En Revista: Urol Oncol Asunto de la revista: NEOPLASIAS / UROLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Macao Pais de publicación: Estados Unidos