Perioperative chemotherapy for muscle-invasive bladder cancer: A population-based outcomes study

Christopher M. Booth, D. Robert Siemens, Gavin Li, Yingwei Peng, Ian F. Tannock, Weidong Kong, David M. Berman, William J. Mackillop

Research output: Contribution to journalArticle

Abstract

BACKGROUND Practice guidelines recommend neoadjuvant chemotherapy (NACT) for bladder cancer. However, the evidence in support of adjuvant chemotherapy (ACT) is less robust. Here we describe whether the evidence of efficacy for NACT/ACT was sufficient to change clinical practice and whether the efficacy demonstrated in clinical trials was translated into effectiveness in the general population. METHODS Electronic records of treatment were linked to the population-based Ontario Cancer Registry to identify all patients with bladder cancer treated with cystectomy in Ontario 1994-2008. Utilization of NACT/ACT was compared across 1994-1998, 1999-2003, and 2004-2008. Logistic regression was used to analyze factors associated with NACT/ACT. Cox model and propensity score analyses were used to explore the association between ACT and survival. RESULTS Two thousand forty-four patients underwent cystectomy for muscle-invasive bladder cancer (MIBC). Use of NACT remained stable (mean, 4%), whereas utilization of ACT increased over time (16%, 18%, 22%; P = .001). Advanced stage (T3/T4; OR, 1.83; 95% CI, 1.38-2.46) and node-positive disease (OR, 8.10; 95% CI, 6.20-10.7) were associated with greater utilization of ACT. Five-year overall survival (OS) and cancer-specific survival (CSS) for all patients was 29% (95% CI, 28%-31%) and 33% (95% CI, 31%-35%), respectively. Utilization of ACT was associated with improved OS (HR, 0.71; 95% CI, 0.62-0.81) and CSS (HR, 0.73; 95% CI, 0.64-0.84). Results were consistent in propensity score analyses. CONCLUSIONS NACT remains substantially underutilized in routine clinical practice. Our results suggest that perioperative chemotherapy is associated with a substantial survival benefit in the general population. Patients who are planning to undergo cystectomy for bladder cancer should be reviewed by a multidisciplinary team.

Original languageEnglish (US)
Pages (from-to)1630-1638
Number of pages9
JournalCancer
Volume120
Issue number11
DOIs
StatePublished - Jun 1 2014
Externally publishedYes

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Adjuvant Chemotherapy
Urinary Bladder Neoplasms
Outcome Assessment (Health Care)
Drug Therapy
Muscles
Population
Survival
Cystectomy
Propensity Score
Ontario
Neoplasms
Practice Guidelines
Proportional Hazards Models
Statistical Factor Analysis
Registries
Logistic Models
Clinical Trials

Keywords

  • bladder cancer
  • chemotherapy
  • health services research
  • knowledge translation
  • outcomes
  • quality of care

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Booth, C. M., Siemens, D. R., Li, G., Peng, Y., Tannock, I. F., Kong, W., ... Mackillop, W. J. (2014). Perioperative chemotherapy for muscle-invasive bladder cancer: A population-based outcomes study. Cancer, 120(11), 1630-1638. https://doi.org/10.1002/cncr.28510

Perioperative chemotherapy for muscle-invasive bladder cancer : A population-based outcomes study. / Booth, Christopher M.; Siemens, D. Robert; Li, Gavin; Peng, Yingwei; Tannock, Ian F.; Kong, Weidong; Berman, David M.; Mackillop, William J.

In: Cancer, Vol. 120, No. 11, 01.06.2014, p. 1630-1638.

Research output: Contribution to journalArticle

Booth, CM, Siemens, DR, Li, G, Peng, Y, Tannock, IF, Kong, W, Berman, DM & Mackillop, WJ 2014, 'Perioperative chemotherapy for muscle-invasive bladder cancer: A population-based outcomes study', Cancer, vol. 120, no. 11, pp. 1630-1638. https://doi.org/10.1002/cncr.28510
Booth CM, Siemens DR, Li G, Peng Y, Tannock IF, Kong W et al. Perioperative chemotherapy for muscle-invasive bladder cancer: A population-based outcomes study. Cancer. 2014 Jun 1;120(11):1630-1638. https://doi.org/10.1002/cncr.28510
Booth, Christopher M. ; Siemens, D. Robert ; Li, Gavin ; Peng, Yingwei ; Tannock, Ian F. ; Kong, Weidong ; Berman, David M. ; Mackillop, William J. / Perioperative chemotherapy for muscle-invasive bladder cancer : A population-based outcomes study. In: Cancer. 2014 ; Vol. 120, No. 11. pp. 1630-1638.
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title = "Perioperative chemotherapy for muscle-invasive bladder cancer: A population-based outcomes study",
abstract = "BACKGROUND Practice guidelines recommend neoadjuvant chemotherapy (NACT) for bladder cancer. However, the evidence in support of adjuvant chemotherapy (ACT) is less robust. Here we describe whether the evidence of efficacy for NACT/ACT was sufficient to change clinical practice and whether the efficacy demonstrated in clinical trials was translated into effectiveness in the general population. METHODS Electronic records of treatment were linked to the population-based Ontario Cancer Registry to identify all patients with bladder cancer treated with cystectomy in Ontario 1994-2008. Utilization of NACT/ACT was compared across 1994-1998, 1999-2003, and 2004-2008. Logistic regression was used to analyze factors associated with NACT/ACT. Cox model and propensity score analyses were used to explore the association between ACT and survival. RESULTS Two thousand forty-four patients underwent cystectomy for muscle-invasive bladder cancer (MIBC). Use of NACT remained stable (mean, 4{\%}), whereas utilization of ACT increased over time (16{\%}, 18{\%}, 22{\%}; P = .001). Advanced stage (T3/T4; OR, 1.83; 95{\%} CI, 1.38-2.46) and node-positive disease (OR, 8.10; 95{\%} CI, 6.20-10.7) were associated with greater utilization of ACT. Five-year overall survival (OS) and cancer-specific survival (CSS) for all patients was 29{\%} (95{\%} CI, 28{\%}-31{\%}) and 33{\%} (95{\%} CI, 31{\%}-35{\%}), respectively. Utilization of ACT was associated with improved OS (HR, 0.71; 95{\%} CI, 0.62-0.81) and CSS (HR, 0.73; 95{\%} CI, 0.64-0.84). Results were consistent in propensity score analyses. CONCLUSIONS NACT remains substantially underutilized in routine clinical practice. Our results suggest that perioperative chemotherapy is associated with a substantial survival benefit in the general population. Patients who are planning to undergo cystectomy for bladder cancer should be reviewed by a multidisciplinary team.",
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AU - Tannock, Ian F.

AU - Kong, Weidong

AU - Berman, David M.

AU - Mackillop, William J.

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N2 - BACKGROUND Practice guidelines recommend neoadjuvant chemotherapy (NACT) for bladder cancer. However, the evidence in support of adjuvant chemotherapy (ACT) is less robust. Here we describe whether the evidence of efficacy for NACT/ACT was sufficient to change clinical practice and whether the efficacy demonstrated in clinical trials was translated into effectiveness in the general population. METHODS Electronic records of treatment were linked to the population-based Ontario Cancer Registry to identify all patients with bladder cancer treated with cystectomy in Ontario 1994-2008. Utilization of NACT/ACT was compared across 1994-1998, 1999-2003, and 2004-2008. Logistic regression was used to analyze factors associated with NACT/ACT. Cox model and propensity score analyses were used to explore the association between ACT and survival. RESULTS Two thousand forty-four patients underwent cystectomy for muscle-invasive bladder cancer (MIBC). Use of NACT remained stable (mean, 4%), whereas utilization of ACT increased over time (16%, 18%, 22%; P = .001). Advanced stage (T3/T4; OR, 1.83; 95% CI, 1.38-2.46) and node-positive disease (OR, 8.10; 95% CI, 6.20-10.7) were associated with greater utilization of ACT. Five-year overall survival (OS) and cancer-specific survival (CSS) for all patients was 29% (95% CI, 28%-31%) and 33% (95% CI, 31%-35%), respectively. Utilization of ACT was associated with improved OS (HR, 0.71; 95% CI, 0.62-0.81) and CSS (HR, 0.73; 95% CI, 0.64-0.84). Results were consistent in propensity score analyses. CONCLUSIONS NACT remains substantially underutilized in routine clinical practice. Our results suggest that perioperative chemotherapy is associated with a substantial survival benefit in the general population. Patients who are planning to undergo cystectomy for bladder cancer should be reviewed by a multidisciplinary team.

AB - BACKGROUND Practice guidelines recommend neoadjuvant chemotherapy (NACT) for bladder cancer. However, the evidence in support of adjuvant chemotherapy (ACT) is less robust. Here we describe whether the evidence of efficacy for NACT/ACT was sufficient to change clinical practice and whether the efficacy demonstrated in clinical trials was translated into effectiveness in the general population. METHODS Electronic records of treatment were linked to the population-based Ontario Cancer Registry to identify all patients with bladder cancer treated with cystectomy in Ontario 1994-2008. Utilization of NACT/ACT was compared across 1994-1998, 1999-2003, and 2004-2008. Logistic regression was used to analyze factors associated with NACT/ACT. Cox model and propensity score analyses were used to explore the association between ACT and survival. RESULTS Two thousand forty-four patients underwent cystectomy for muscle-invasive bladder cancer (MIBC). Use of NACT remained stable (mean, 4%), whereas utilization of ACT increased over time (16%, 18%, 22%; P = .001). Advanced stage (T3/T4; OR, 1.83; 95% CI, 1.38-2.46) and node-positive disease (OR, 8.10; 95% CI, 6.20-10.7) were associated with greater utilization of ACT. Five-year overall survival (OS) and cancer-specific survival (CSS) for all patients was 29% (95% CI, 28%-31%) and 33% (95% CI, 31%-35%), respectively. Utilization of ACT was associated with improved OS (HR, 0.71; 95% CI, 0.62-0.81) and CSS (HR, 0.73; 95% CI, 0.64-0.84). Results were consistent in propensity score analyses. CONCLUSIONS NACT remains substantially underutilized in routine clinical practice. Our results suggest that perioperative chemotherapy is associated with a substantial survival benefit in the general population. Patients who are planning to undergo cystectomy for bladder cancer should be reviewed by a multidisciplinary team.

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