MP71-20 COMPARATIVE EFFECTIVENESS OF NEOADJUVANT AND ADJUVANT CHEMOTHERAPY IN THE MEDICARE BLADDER CANCER POPULATION

Abstract

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation II1 Apr 2018MP71-20 COMPARATIVE EFFECTIVENESS OF NEOADJUVANT AND ADJUVANT CHEMOTHERAPY IN THE MEDICARE BLADDER CANCER POPULATION Mina Fam, Jonathan Yabes, Nathan Hale, Robert Turner, Jathin Bandari, Liam Macleod, Lee Hugar, Jeffrey Gingrich, Tudor Borza, Ted Skolarus, Benjamin Davies, and Bruce Jacobs Mina FamMina Fam More articles by this author , Jonathan YabesJonathan Yabes More articles by this author , Nathan HaleNathan Hale More articles by this author , Robert TurnerRobert Turner More articles by this author , Jathin BandariJathin Bandari More articles by this author , Liam MacleodLiam Macleod More articles by this author , Lee HugarLee Hugar More articles by this author , Jeffrey GingrichJeffrey Gingrich More articles by this author , Tudor BorzaTudor Borza More articles by this author , Ted SkolarusTed Skolarus More articles by this author , Benjamin DaviesBenjamin Davies More articles by this author , and Bruce JacobsBruce Jacobs More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2284AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The administration of chemotherapy along with radical cystectomy in patients with muscle-invasive bladder cancer has shown to improve survival rates, but the timing (e.g., neoadjuvant versus adjuvant) has not been rigorously tested. We examined the comparative effectiveness of neoadjuvant and adjuvant chemotherapy on survival outcomes in cystectomy patients. METHODS Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified patients with muscle-invasive bladder cancer who were diagnosed between 2004-2013 and treated with radical cystectomy. We further identified patients who received neoadjuvant or adjuvant chemotherapy. We compared unadjusted overall survival using the Kaplan-Meier method and log-rank test across groups. To control for potential confounders in our multivariable survival models, we then estimated the propensity of receiving adjuvant chemotherapy using gradient boosted models. The propensity score model included the following variables: age, sex, race, Charlson Comorbidity Index, marital status, education, population size, median income, region, year of cystectomy, grade, stage, and nodal status. The propensity scores were used to construct inverse probability weighted survival curves. RESULTS We identified 1,342 patients who underwent either neoadjuvant (n=676) or adjuvant chemotherapy (n=666). In unadjusted analyses, the adjuvant group had worse overall survival compared to the neoadjuvant group (Hazard Ratio (HR) 1.46 (95% Confidence Interval (CI) 1.28-1.67), p <0.001). After propensity score adjustment, the overall survival in the adjuvant group was still worse (adjusted HR 1.18 (CI 1.02-1.36), p=0.022) (Figure). Regardless of chemotherapy timing, half of the patients in each group survived two years or less after cystectomy (see shaded box in figure). CONCLUSIONS Overall survival for radical cystectomy patients receiving neoadjuvant chemotherapy was better than those receiving adjuvant chemotherapy in both unadjusted and propensity score adjusted analyses, but remained poor. While this comparative effectiveness finding supports neoadjuvant chemotherapy use, the largest gains in quantity and quality of life after cystectomy and chemotherapy are likely to occur within the first 2 years after treatment. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e951 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Mina Fam More articles by this author Jonathan Yabes More articles by this author Nathan Hale More articles by this author Robert Turner More articles by this author Jathin Bandari More articles by this author Liam Macleod More articles by this author Lee Hugar More articles by this author Jeffrey Gingrich More articles by this author Tudor Borza More articles by this author Ted Skolarus More articles by this author Benjamin Davies More articles by this author Bruce Jacobs More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...