Unconventional Bladder Preservation: Factors Predicting Failure to Receive Definitive Surgery following Chemotherapy for Nonmetastatic Muscle Invasive Bladder Cancer in the National Cancer Database
| Autor: | Jen-Jane Liu, Akash Kapadia, Ann Martinez Acevedo, Ryan Kopp, Christopher L. Amling, Mark Garzotto, Michael J. Conlin |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male Databases Factual Urology medicine.medical_treatment 030232 urology & nephrology Cystectomy computer.software_genre Cohort Studies 03 medical and health sciences 0302 clinical medicine medicine Humans Neoplasm Invasiveness Aged Aged 80 and over Carcinoma Transitional Cell Chemotherapy Bladder cancer Database Proportional hazards model business.industry Cancer Middle Aged medicine.disease Combined Modality Therapy Neoadjuvant Therapy Radiation therapy Urinary Bladder Neoplasms 030220 oncology & carcinogenesis Inclusion and exclusion criteria Female business Organ Sparing Treatments computer Cohort study |
| Zdroj: | Journal of Urology. 200:535-540 |
| ISSN: | 1527-3792 0022-5347 |
| Popis: | Neoadjuvant chemotherapy is an important adjunct to cystectomy for managing muscle invasive bladder cancer. Using the National Cancer Database we investigated factors that predict failure to undergo surgery following multi-agent chemotherapy for nonmetastatic muscle invasive bladder cancer.We performed a cohort study in patients diagnosed with cT2-4aN0M0 urothelial cell carcinoma of the bladder between 2004 and 2013 who underwent multi-agent chemotherapy. We excluded those with surgery prior to chemotherapy, clinical T4b disease and those who received radiotherapy. Socioeconomic and clinical predictors, including time from diagnosis to treatment, were analyzed using logistic regression for the receipt of surgery after chemotherapy. Cox proportional hazards modeling was applied to perform time dependent analysis.Of the 4,640 patients who met our study inclusion and exclusion criteria 4,244 (91%) proceeded to surgery. Negative predictors of surgery included African American or Hispanic race (OR 0.58, p = 0.007 and 0.48, p = 0.002, respectively), increasing age (OR 0.44, p0.001) and greater time between diagnosis and chemotherapy initiation (fourth quartile greater than 59 days, OR 0.51, p0.001). African American race (HR 0.79, p0.001), Medicare (HR 0.86, p 0.001) and other government insurance (HR 0.73, p0.001) were associated with delayed chemotherapy.Increasing age, African American or Hispanic race and longer time to chemotherapy predicted failure to undergo surgery. Furthermore, African American race was associated with delayed chemotherapy. Chemotherapy was also delayed in patients on Medicare or other government insurance. Longer time to neoadjuvant chemotherapy is a modifiable risk factor that should be closely observed in multimodal cancer treatment. |
| Databáze: | OpenAIRE |
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