788O - Neoadjuvant (NACT) and adjuvant chemotherapy (ACT) for muscle-invasive bladder cancer: a population-based outcomes study

Date 30 September 2012
Event ESMO Congress 2012
Session Genitourinary tumors, bladder and testicular cancer
Topics Anti-Cancer Agents & Biologic Therapy
Urothelial Cancers
Presenter Christopher Booth
Authors C.M. Booth1, D.R. Siemens2, G. Li2, Y. Peng2, I.F. Tannock3, D.M. Berman2, W. Kong2, W. Mackillop2
  • 1Oncology Dept., Queen's University Cancer Research Institute, K7L 5P9 - Kingston/CA
  • 2Dept Of Oncology, Queen's University Cancer Research Institute, K7L 5P9 - Kingston/CA
  • 3Dept Of Medical Oncology, Princess Margaret Hospital, Toronto/CA

Abstract

Background

Utilization of NACT and ACT for bladder cancer in the general population and the survival benefit associated with therapy is not well described. Here we report practice patterns and outcomes associated with NACT/ACT in the general population of Ontario, Canada.

Methods

Electronic records of treatment were linked to the population-based Ontario Cancer Registry to identify all patients who underwent cystectomy for bladder cancer in Ontario 1994–2008. Surgical pathology reports were obtained to identify cases with muscle-invasive disease. Utilization of NACT/ACT was compared across 3 study periods: 1994–98, 1999–03, 2004–08. Logistic regression was used to analyze factors associated with use of NACT/ACT. A Cox model and propensity score analysis was used to explore the association between ACT and survival.

Results

In 1994–2008 4876 patients underwent cystectomy. Surgical pathology reports were identified for 3429 cases; 2738 had muscle-invasive disease. While use of NACT did not change over the 3 study periods (5%, 3%, 6%; p = 0.004), utilization of ACT increased with time (16%, 19%, 23%; p = 0.001). In adjusted analyses younger age and less co-morbidity were associated with greater utilization of NACT/ACT. T3/T4 tumors (OR 2.1, 95%CI 1.6–2.8), node positive disease (OR 7.2, 95%CI 5.5–9.5), and lymphovascular invasion (OR 1.7, 95%CI 1.2–2.3) were associated with greater utilization of ACT. While there was no substantial variation in utilization of NACT across geographic regions (range 3% to 5%), use of ACT varied considerably (range 12% to 31%). Five year overall (OS) and cancer-specific survival (CSS) for all muscle-invasive cases was 30% (95%CI 28–31%) and 34% (95%CI 32–36%). In Cox analysis T3/T4 tumors (HR 1.7, 95%CI 1.6-2.0), node positive disease (HR 1.9, 95%CI 1.7–2.1), and lymphovascular invasion (HR 1.8, 95%CI 1.6–2.1) were associated with inferior OS. Utilization of ACT was associated with improved OS (HR 0.70, 95%CI 0.6–0.8) and improved CSS (HR 0.70, 95%CI 0.6–0.8). This result was consistent in the Cox model and propensity score analysis.

Conclusions

Despite accumulating evidence and guidelines, NACT/ACT remains substantially underutilized in routine clinical practice. Our results suggest that ACT is associated with a substantial survival benefit in the general population.

Disclosure

All authors have declared no conflicts of interest.