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.
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.
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.
While IVC use has increased since being added to the EAU UTUC guidelines, its use remains low at academic centers, particularly within Europe.
Urologic oncology. 2022 Aug 04 [Epub ahead of print]
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 Mottrie, Giuseppe Simone, Adam C Reese, Daniel D Eun, Amit Satish Bhattu, Mark L Gonzalgo, Umberto Carbonara, Riccardo Autorino, Vitaly Margulis
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX., Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA., Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, University of Florence, Careggi Hospital, Florence, Italy., Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI., Department of Urology, Indiana University School of Medicine, Indianapolis, IN., Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA., Division of Urology, IRCCS European Institute of Oncology, Milan, Italy., Department of Urology, UCSD School of Medicine, La Jolla, CA., Department of Urology, Changzheng Hospital, Second Military (Naval) Medical University, Shanghai, China., Swedish Urology Group, Seattle, WA., Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY., Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium., Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy., Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA., Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL., Division of Urology and Massey Cancer Center, VCU Health System, Richmond, VA., Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address: .