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ORIGINAL ARTICLE   Free accessfree

Minerva Urologica e Nefrologica 2017 April;69(2):173-80

DOI: 10.23736/S0393-2249.16.02713-2


lingua: Inglese

Use of adjuvant chemotherapy in radical cystectomy patients aged >65 years: a population-based study from the surveillance epidemiology and end results (SEER)-medicare database

Jonas SCHIFFMANN 1, 2, Maxine SUN 1, Giorgio GANDAGLIA 1, 3, 4, Zeh TIAN 1, Ioana POPA 1, 5, Alessandro LARCHER 1, 3, 4, Alberto BRIGANTI 4, Michael McCORMACK 5, Shahrokh F. SHARIAT 6, Francesco MONTORSI 3, 4, Markus GRAEFEN 2, Fred SAAD 5, Pierre I. KARAKIEWICZ 1, 5

1 Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; 2 Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany; 3 Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy; 4 Department of Urology, Vita-Salute San Raffaele University, Milan, Italy; 5 Department of Urology, University of Montreal Health Center, Montreal, Canada; 6 Department of Urology, Medical University of Vienna, Vienna, Austria


BACKGROUND: The role of adjuvant chemotherapy (AC) within urothelial carcinoma of the urinary bladder (UCUB) patients after radical cystectomy (RC) is under debate. We assessed contemporary AC utilization rates. We also examined the rates of AC according to patient disease and sociodemographic characteristics.
METHODS: We relied on the SEER-Medicare database for non-organ-confined, muscle-invasive T2 N+ –T4a UCUB patients who underwent RC between 1991 and 2009 without neoadjuvant chemotherapy delivery. Multivariable logistic regression analyses tested predictors of AC use; T-stage, N-stage, year of diagnosis, age, gender, race, radiotherapy (RT) administration, marital urban and socioeconomic status, tumor grade and Charlson Comorbidity Index (CCI).
RESULTS: Overall, 2681 patients were identified. Of those, 667 (24.9%) received AC. The rate of AC were 21.4%, 23.5%, 24.6% and 29.9% over time (1991-1999 vs. 2000-2002 vs. 2003-2005 vs. 2006-2009) (P=0.002). In multivariable analyses stages pT2N+ (odds ratio (OR): 4.7; P<0.001) and pT3/4aN+ (OR: 4.0; P<0.001), year of diagnosis (OR: 1.9; P<0.001), RT (OR: 1.7; P<0.001), married status (OR: 1.4; P=0.001) and advanced age (OR: 0.3; P<0.001) were independent predictors of AC. Neither race nor CCI demonstrated significance.
CONCLUSIONS: In conclusion, we report lower than anticipated overall (24.9%) use of AC. Nonetheless, the rate increased from 13.6% (1991) to 24.1% (2009). Presence of lymph node invasion at RC regardless of T2 or T3/4a stage was the most important variable that increased AC use. Older and unmarried individuals were less likely to receive AC. AC rates were higher in T2N+ UCUB patients than in T3-T4a individuals.

KEY WORDS: Chemotherapy, adjuvant - Urinary bladder neoplasms - Cystectomy - Carcinoma

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