Trends in the Use of Chemotherapy before and after Radical Cystectomy in Patients with Muscle-invasive Bladder Cancer in Korea

Abstract

We investigated trends in perioperative chemotherapy use, and determined factors associated with neoadjuvant chemotherapy (NAC) and adjuvant chemotherapy (AC) use in Korean patients with muscle-invasive bladder cancer (MIBC). We recruited 1,324 patients who had MIBC without nodal invasion or metastases and had undergone radical cystectomies (RC) between 2003 and 2013. The study's cut-off time for AC was three months after surgery, and the study's timespan was divided into three periods based on NAC use, namely, 2003-2005, 2006-2009, and 2010-2013. Complete remission was defined as histologically confirmed T0N0M0 after RC. NAC and AC were administered to 7.3% and 18.1% of the patients, respectively. The median time interval between completing NAC and undergoing RC was 32 days and the mean number of cycles was 3.2. The median time interval between RC and AC was 43 days and the mean number of cycles was 4.1. Gemcitabine and cisplatin were most frequently used in combination for NAC (49.0%) and AC (74.9%). NAC use increased significantly from 4.6% between 2003 and 2005 to 8.4% between 2010 and 2013 (P < 0.05), but AC use did not increase. Only 1.9% of patients received NAC and AC. Complete remission after NAC was achieved in 12 patients (12.5%). Multivariable modeling revealed that an advanced age, the earliest time period analyzed, and clinical tumor stage ≤ cT2 bladder cancer were negatively associated with NAC use (P < 0.05). While NAC use has slowly increased over time, it remains an underutilized therapeutic approach in Korean clinical practice.

Acceptance of Adjuvant and Neoadjuvant Chemotherapy in Muscle-Invasive Bladder Cancer in Germany: A Survey of Current Practice

“…Although evidence suggests a survival benefit of 5% at 5 years for NAC, usage in clinical practice is rather low with approximately 20% [11, 12], whereas AC seems more popular despite limited evidence [11, 13]. With the present work, we show a high acceptance of NAC among ­German urologists.…”

Trends and disparities in the use of neoadjuvant chemotherapy for muscle-invasive urothelial carcinoma

“…In South Korea, Kim et al noted very low NAC utilization rates of 8.4% in 2013. Although very low, the author's state utilization had increased significantly from prior years 16 . They believe the low utilization rates observed in their study relates to health care policy in their country and the lack of national support for NAC use.…”

Bladder Cancer Chemosensitivity Is Affected by Paraoxonase-2 Expression

“…To improve the outcome of clinical N0M0 patients with muscle-invasive BC, the addition of chemotherapy (neoadjuvant before radical cystectomy or adjuvant after surgery) is used [18]. The advantages of neoadjuvant chemotherapy are the presumed low burden of micrometastatic disease, the ability to test the chemosensitivity by following the primary tumor, and the expected better tolerability of chemotherapy before rather than after surgery.…”