The Use of Neoadjuvant Chemotherapy in Patients With Urothelial Carcinoma of the Bladder: Current Practice Among Clinicians
The Use of Neoadjuvant Chemotherapy in Patients With Urothelial Carcinoma of the Bladder: Current Practice Among Clinicians
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DOI：
10.1016/j.clgc.2016.09.003
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发表时间：
2017-06-01
影响因子：
3.2
通讯作者：
Bolenz, Christian
中科院分区：
文献类型：
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作者：
Martini, Thomas;Gilfrich, Christian;Bolenz, Christian
对于临床分期为T2-T4a， cN0M0的膀胱癌患者，建议在根治性膀胱切除术前行新辅助化疗。我们使用单变量和多变量回归分析和问卷调查分析了679例患者的新辅助化疗的频率和当前实践。尽管医学指征和跨学科肿瘤委员会讨论，我们发现指南建议和实践模式之间存在很大差异。导言：指南推荐临床分期为T2-T4a， cN0M0的尿路上皮性膀胱癌患者在根治性膀胱切除术（RC）前进行新辅助化疗（NAC）。我们检查了NAC的频率和当前实践，并试图确定NAC在前瞻性当代队列中使用的预测因素。材料和方法：我们分析了PROMETRICS（2011年前瞻性多中心根治性膀胱切除术系列）数据库中679名患者的前瞻性数据。所有患者在2011年接受了RC。单变量和多变量回归分析确定了NAC应用的预测因子。此外，我们使用问卷来评估PROMETRICS中心NAC的实践模式。结果：共纳入235例患者（35%）。只有15例患者（2.2%）在RC前接受了NAC。年龄较小（< 70岁，P = 0.035）、中心体积较小（< 30 RC/年，P < 0.001）和肿瘤分期较晚（>= cT3, P = 0.038）被认为是NAC的预测因素。在回答问卷的200名泌尿科医生中，69% （n = 125）认为肿瘤分期cT3-4 a/o N1M0是NAC应用的最佳适应症，尽管45%的泌尿科医生表示尽管有建议，他们不会实施NAC。在69%的病例中，NAC的决定是由泌尿科医生做出的，只有29%的病例报告所有病例都在跨学科肿瘤委员会中进行了讨论。结论：NAC在本队列中应用较少。我们观察到指南建议和实践模式之间的差异，尽管医学指征和治疗前跨学科的讨论。NAC在多模式方法中的潜在益处似乎被许多泌尿科医生所忽视。(C) 2016 Elsevier Inc.版权所有。
Neoadjuvant chemotherapy before radical cystectomy is recommended in patients with bladder cancer in clinical stages T2-T4a, cN0M0. We analyzed the frequency and current practice of neoadjuvant chemotherapy in 679 patients using uni- and multivariable regression analyses and using a questionnaire. We found a great discrepancy between guideline recommendations and practice patterns, despite medical indication and interdisciplinary tumor board discussion.Introduction: Guidelines recommend neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) in patients with urothelial carcinoma of the bladder in clinical stages T2-T4a, cN0M0. We examined the frequency and current practice of NAC and sought to identify predictors for the use of NAC in a prospective contemporary cohort. Materials and Methods: We analyzed prospective data from 679 patients in the PROMETRICS (PROspective MulticEnTer Radical Cystectomy Series 2011) database. All patients underwent RC in 2011. Uni- and multivariable regression analyses identified predictors of NAC application. Furthermore, a questionnaire was used to evaluate the practice patterns of NAC at the PROMETRICS centers. Results: A total of 235 patients (35%) were included in the analysis. Only 15 patients (2.2%) received NAC before RC. Younger age (< 70 years; P = .035), lower case volume of the center (< 30 RC/year; P < .001), and advanced tumor stage (>= cT3; P = .038) were identified as predictors for NAC. Of the 200 urologists who replied to the questionnaire, 69% (n = 125) declared tumor stage cT3-4 a/o N1M0 to be the best indication for NAC application, although 45% of the urologists stated that they would not perform NAC despite recommendations. The decision for NAC was made by the individual urologist in 69% of cases, and only 29% reported that all cases were discussed in an interdisciplinary tumor board. Conclusion: NAC was rarely applied in the present cohort. We observed a discrepancy between guideline recommendations and practice patterns, despite medical indication and pre-therapeutic interdisciplinary discussion. The potential benefit of NAC within a multimodal approach seems to be neglected by many urologists. (C) 2016 Elsevier Inc. All rights reserved.