TY - JOUR
T1 - Practice trends for perioperative intravesical chemotherapy in upper tract urothelial carcinoma
T2 - Low but increasing utilization during minimally invasive nephroureterectomy
AU - Kenigsberg, Alexander P.
AU - Carpinito, Gianpaolo
AU - Gold, Samuel A.
AU - Meng, Xiaosong
AU - Ghoreifi, Alireza
AU - Djaladat, Hooman
AU - Minervini, Andrea
AU - Jamil, Marcus
AU - Abdollah, Firas
AU - Farrow, Jason M.
AU - Sundaram, Chandru
AU - Uzzo, Robert
AU - Ferro, Matteo
AU - Meagher, Margaret
AU - Derweesh, Ithaar
AU - Wu, Zhenjie
AU - Porter, James
AU - Katims, Andrew
AU - Mehrazin, Reza
AU - Mottrie, Alex
AU - Simone, Giuseppe
AU - Reese, Adam C.
AU - Eun, Daniel D.
AU - Bhattu, Amit Satish
AU - Gonzalgo, Mark L.
AU - Carbonara, Umberto
AU - Autorino, Riccardo
AU - Margulis, Vitaly
N1 - Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/10
Y1 - 2022/10
N2 - Introduction: Perioperative intravesical chemotherapy (IVC) at or around the time of radical nephroureterectomy (RNU) reduces the risk of intravesical recurrence. Guidelines since 2013 have recommended its use. The objective of this study is to examine IVC utilization and determine predictors of its administration within a large international consortium. Methods and materials: Data was collected from 17 academic centers on patients who underwent robotic/laparoscopic RNU between 2006 and 2020. Patients who underwent concomitant radical cystectomy and cases in which IVC administration details were unknown were excluded. Univariate and multivariate analyses were utilized to determine predictors of IVC administration. A Joinpoint regression was performed to evaluate utilization by year. Results: Six hundred and fifty-nine patients were included. A total of 512 (78%) did not receive IVC while 147 (22%) did. Non-IVC patients were older (P < 0.001), had higher ECOG scores (P = 0.003), and had more multifocal disease (23% vs. 12%, P = 0.005). Those in the IVC group were more likely to have higher clinical T stage disease (P = 0.008), undergone laparoscopic RNU (83% vs. 68%, P < 0.001), undergone endoscopic management of the bladder cuff (20% vs. 4%, P = 0.008). Multivariable regression showed that decreased age (OR 0.940, P < 0.001), laparoscopic approach (OR 2.403, P = 0.008), and endoscopic management of the bladder cuff (OR 7.619, P < 0.001) were significant predictors favoring IVC administration. Treatment at a European center was associated with lower IVC use (OR 0.278, P = 0.018). Overall utilization of IVC after the 2013 European Association of Urology (EAU) guideline was 24% vs. 0% prior to 2013 (P < 0.001). Limitations include limited data regarding IVC timing/agent and inclusion of minimally invasive RNU patients only. Conclusions: While IVC use has increased since being added to the EAU UTUC guidelines, its use remains low at academic centers, particularly within Europe.
AB - Introduction: Perioperative intravesical chemotherapy (IVC) at or around the time of radical nephroureterectomy (RNU) reduces the risk of intravesical recurrence. Guidelines since 2013 have recommended its use. The objective of this study is to examine IVC utilization and determine predictors of its administration within a large international consortium. Methods and materials: Data was collected from 17 academic centers on patients who underwent robotic/laparoscopic RNU between 2006 and 2020. Patients who underwent concomitant radical cystectomy and cases in which IVC administration details were unknown were excluded. Univariate and multivariate analyses were utilized to determine predictors of IVC administration. A Joinpoint regression was performed to evaluate utilization by year. Results: Six hundred and fifty-nine patients were included. A total of 512 (78%) did not receive IVC while 147 (22%) did. Non-IVC patients were older (P < 0.001), had higher ECOG scores (P = 0.003), and had more multifocal disease (23% vs. 12%, P = 0.005). Those in the IVC group were more likely to have higher clinical T stage disease (P = 0.008), undergone laparoscopic RNU (83% vs. 68%, P < 0.001), undergone endoscopic management of the bladder cuff (20% vs. 4%, P = 0.008). Multivariable regression showed that decreased age (OR 0.940, P < 0.001), laparoscopic approach (OR 2.403, P = 0.008), and endoscopic management of the bladder cuff (OR 7.619, P < 0.001) were significant predictors favoring IVC administration. Treatment at a European center was associated with lower IVC use (OR 0.278, P = 0.018). Overall utilization of IVC after the 2013 European Association of Urology (EAU) guideline was 24% vs. 0% prior to 2013 (P < 0.001). Limitations include limited data regarding IVC timing/agent and inclusion of minimally invasive RNU patients only. Conclusions: While IVC use has increased since being added to the EAU UTUC guidelines, its use remains low at academic centers, particularly within Europe.
KW - Intravesical chemotherapy
KW - Nephroureterectomy
KW - Practice trends
KW - Upper tract urothelial carcinoma
UR - http://www.scopus.com/inward/record.url?scp=85135532531&partnerID=8YFLogxK
U2 - 10.1016/j.urolonc.2022.06.006
DO - 10.1016/j.urolonc.2022.06.006
M3 - Article
C2 - 35934609
AN - SCOPUS:85135532531
SN - 1078-1439
VL - 40
SP - 452.e17-452.e23
JO - Urologic Oncology: Seminars and Original Investigations
JF - Urologic Oncology: Seminars and Original Investigations
IS - 10
ER -