J Korean Med Sci.  2015 Aug;30(8):1150-1156. 10.3346/jkms.2015.30.8.1150.

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

• Kim SH
• Seo HK
• Shin HC
• Chang SJ
• Yun S
• Joo J
• Ku JH
• Kim HS
• Jeon HG
• Jeong BC
• Jeong IG
• Kang SH
• Hong B
• UCART (urothelial cancer-advanced research and treatment group in Korea) group

• KMID: 2164511
• DOI: http://doi.org/10.3346/jkms.2015.30.8.1150

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 < or = 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.

Keyword

Urinary Bladder Neoplasms; Neoadjuvant Therapy; Adjuvant; Chemotherapy; Cystectomy

MeSH Terms

Adult
Aged
Aged, 80 and over
Antineoplastic Agents/*therapeutic use
Chemotherapy, Adjuvant/trends/utilization
Cystectomy/trends/*utilization
Drug Administration Routes
Drug Administration Schedule
Female
Health Services Misuse/statistics & numerical data/trends
Humans
Male
Middle Aged
Muscle, Smooth/*pathology
Neoadjuvant Therapy/statistics & numerical data/trends
Neoplasm Invasiveness
Practice Patterns, Physicians'/statistics & numerical data/trends
Prevalence
Republic of Korea/epidemiology
Risk Factors
Treatment Outcome
Urinary Bladder Neoplasms/epidemiology/*pathology/*therapy
Antineoplastic Agents

Figure

• 

  Fig. 1 Changes in neoadjuvant chemotherapy and adjuvant chemotherapy in patients with muscle invasive bladder cancer between 2003 and 2013.

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