The Use of Neoadjuvant Chemotherapy in Patients With Urothelial Carcinoma of the Bladder: Current Practice Among Clinicians

作者：Martini Thomas; Gilfrich Christian; Mayr Roman; Burger Maximilian; Pycha Armin; Aziz Atiqullah; Gierth Michael; Stief Christian G; Mueller Stefan C; Wagenlehner Florian; Roigas Jan; Hakenberg Oliver W; Roghmann Florian; Nuhn Philipp; Wirth Manfred; Novotny Vladimir; Hadaschik Boris; Grimm Marc Oliver; Schramek Paul; Haferkamp Axel; Colleselli Daniela; Kloss Birgit; Herrmann Edwin; Fisch Margit; May Matthias; Bolenz Christian

来源：Clinical Genitourinary Cancer, 2017, 15(3): 356-362.

DOI：10.1016/j.clgc.2016.09.003

• Guideline recommendation
• Muscle-invasive bladder cancer
• Questionnaire
• Radical cystectomy
• Tumor board

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.

• 出版日期2017-6