MIBC: RC delay after NACT, TURBT tied to poorer survival

  • Chu AT & al.
  • Cancer
  • 6 Mar 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • In patients with muscle-invasive bladder cancer (MIBC), delay in radical cystectomy (RC) of >12 weeks after transurethral resection of bladder tumor (TURBT) or 11 weeks after neoadjuvant chemotherapy (NACT) is associated with poorer OS.
  • Rural neighborhood and change in TURBT and RC provider were associated with RC delays without NACT.

Why this matters

  • Findings highlight health disparities on timely access to complex surgical care and care coordination.

Study design

  • Study of 1509 patients with MIBC who underwent RC.
  • Funding: University of Washington School of Medicine III Relocation Stipend and Howard J. Cohen Bladder Cancer Foundation.

Key results

  • 18% of patients received NACT.
  • Mean time from TURBT to NACT, 69 days.
  • RC delays did not worsen survival in patients aged >80 years (P=.67).
  • RC delay of >12 weeks after TURBT or >11 weeks after NACT was associated with increased risk for overall mortality vs timely surgery:
    • no NACT (age
    • after NACT (all patients): HR, 1.63 (95% CI, 1.06-2.52).
  • Factors associated with RC delays in patients without NACT were high poverty or nonmetropolitan neighborhood, change in TURBT and RC provider, male sex.
  • In patients who received NACT, a lymph node-positive status was associated with increased mortality.

Limitations

  • Retrospective design.

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