Practice trends for perioperative intravesical chemotherapy in upper tract urothelial carcinoma: Low but increasing utilization during minimally invasive nephroureterectomy

Alexander P. Kenigsberg, Gianpaolo Carpinito, Samuel A. Gold, Xiaosong Meng, Alireza Ghoreifi, Hooman Djaladat, Andrea Minervini, Marcus Jamil, Firas Abdollah, Jason M. Farrow, Chandru Sundaram, Robert Uzzo, Matteo Ferro, Margaret Meagher, Ithaar Derweesh, Zhenjie Wu, James Porter, Andrew Katims, Reza Mehrazin, Alex MottrieGiuseppe Simone, Adam C. Reese, Daniel D. Eun, Amit Satish Bhattu, Mark L. Gonzalgo, Umberto Carbonara, Riccardo Autorino, Vitaly Margulis

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)452.e17-452.e23
JournalUrologic Oncology: Seminars and Original Investigations
Volume40
Issue number10
DOIs
StatePublished - Oct 2022

Keywords

  • Intravesical chemotherapy
  • Nephroureterectomy
  • Practice trends
  • Upper tract urothelial carcinoma

Fingerprint

Dive into the research topics of 'Practice trends for perioperative intravesical chemotherapy in upper tract urothelial carcinoma: Low but increasing utilization during minimally invasive nephroureterectomy'. Together they form a unique fingerprint.

Cite this