Abstract

PURPOSE:

Neoadjuvant chemotherapy (NAC) prior to radical cystectomy (RC) improves overall survival in muscle-invasive bladder cancer (MIBC), but successful completion rates of NAC are low. A retrospective analysis was undertaken to determine the etiology of deviations of NAC administration for MIBC.

METHODS:

We performed a retrospective review of MIBC patients in an institutional database who received NAC followed by RC from 2008 to 2016. Patients were characterized as having completed NAC without deviation (“No Deviation”) or with deviation (“Deviation”). Factors associated with “Deviation” were assessed with logistic regression models.

RESULTS:

172 MIBC patients received NAC followed by RC; 49 were excluded due to incomplete NAC data. Of the remaining 123 patients, 80 (65%) received Gemcitabine and Cisplatin (GC) and 25 (20%) received dose-dense MVAC (ddMVAC). In all, 85 (69%) patients had “Deviation” in planned NAC administration, while the remaining 38 (31%) patients had “No Deviation.” Twenty-six (33%) of GC patients experienced delays (mean = 21.5±17.0 days) and 6 (24%) ddMVAC patients experienced delays (mean = 10.5±9.5 days). Receipt of GC was associated with higher likelihood of “Deviation” in comparison to ddMVAC (OR = 15.4; 95% CI 4.43–53.72, p < 0.01), and administration of NAC at our institution was associated with lower likelihood of “Deviation” in comparison to receipt in the community (OR = 0.25; 95% CI 0.25–0.72, p = 0.01).

CONCLUSIONS:

Deviations in administration of NAC were common in our cohort (69%) and were associated with receipt of GC and administration of NAC at an outside institution.

中文翻译：

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肌浸润性膀胱癌新辅助化疗患者治疗延迟的病因学

摘要

目的：

根治性膀胱切除术（RC）之前的新辅助化疗（NAC）改善了肌肉浸润性膀胱癌（MIBC）的总体生存率，但NAC的成功完成率很低。进行回顾性分析，以确定MIAC的NAC给药偏差的病因。

方法：

我们对机构数据库中的MIBC患者进行了回顾性审查，这些患者在2008年至2016年期间接受了NAC，随后接受了RC。患者的特征是完成了NAC而没有偏差（“无偏差”）或有偏差（“偏差”）。用逻辑回归模型评估与“偏差”相关的因素。

结果：

172例MIBC患者接受NAC治疗，随后进行RC治疗；由于NAC数据不完整，排除了49个。在其余的123名患者中，有80名（65％）接受了吉西他滨和顺铂（GC）的治疗，而25名（20％）接受了剂量密集的MVAC（ddMVAC）的治疗。在计划的NAC给药中，共有85名患者（69％）出现了“偏差”，而其余38名患者（31％）出现了“无偏差”。二十二名（33％）的GC患者出现延误（平均= 21.5±17.0天），六名（24％）ddMVAC患者出现延误（平均= 10.5±9.5天）。与ddMVAC相比，GC的接收与“偏倚”的可能性更高（OR = 15.4； 95％CI 4.43–53.72，p  <0.01），而在我们机构进行NAC的管理与较低的“偏倚”可能性有关。与社区收入的比较（OR = 0.25； 95％CI 0.25–0.72，p = 0.01）。

结论：

NAC的管理偏差在我们的队列中很常见（69％），并且与接受GC和在外部机构管理NAC有关。