PD44-05 AGE RELATED TRENDS IN THE UTILIZATION OF NEOADJUVANT CHEMOTHERAPY FOR MUSCLE INVASIVE BLADDER CANCER

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD44-05 AGE RELATED TRENDS IN THE UTILIZATION OF NEOADJUVANT CHEMOTHERAPY FOR MUSCLE INVASIVE BLADDER CANCER Jeffrey Orf, Dominic Barressi, Facundo Davaro, Mohammad Mahmoud, and Zachary Hamilton Jeffrey OrfJeffrey Orf More articles by this author , Dominic BarressiDominic Barressi More articles by this author , Facundo DavaroFacundo Davaro More articles by this author , Mohammad MahmoudMohammad Mahmoud More articles by this author , and Zachary HamiltonZachary Hamilton More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003354.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: 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. METHODS: The National Cancer Database (NCDB) was quarried for patients with cT2-4NanyM0 MIBC treated with RC from 2010-2016 with urothelial carcinoma. 19,957 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 2010-2016 (Figure 1). Receipt of NAC was associated with decreased age on univariate analysis (p<.001) and on logistic regression (odds ratio (OR): 0.62 age 70-79, OR: 0.22 age≥80 vs.<60; p<.001). At time of RC for those who underwent NAC, the rate of pathologic downstaging decreased with increasing age (p<.001). Logistical regression also revealed a positive association between pathologic downstaging and younger age after receipt of NAC (OR: 0.73 age 70-79, OR: 0.61≥80 vs.<60; p<.001). Among patients receiving NAC, the risk of 30 and 90-day mortality was associated with increasing age (p<.002 and p<.001 respectively); however, age was not associated with 30-day readmission for those receiving NAC. CONCLUSIONS: Rates of NAC use prior to RC have increased among all age groups with the lowest utilization rate among the elderly. Younger patients were more likely to see pathologic downstaging at time of RC after NAC. 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 pathologic downstaging remains unknown. Source of Funding: n/a © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1126 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeffrey Orf More articles by this author Dominic Barressi More articles by this author Facundo Davaro More articles by this author Mohammad Mahmoud More articles by this author Zachary Hamilton More articles by this author Expand All Advertisement PDF downloadLoading ...