Introduction

Patients with pT1 bladder cancer (BCa) are at high-risk of recurrence and progression and thus need proper treatment. We aimed to mirror contemporary guideline-adherence in the context of pT1 BCa treatment in a German multicenter study.

Methods

111 patients with first-time diagnosis of pT1 BCa were treated at four centers. Guideline-adherence was defined as 2nd resection, instillation therapy, and quarterly cystoscopic follow-up. Patient characteristics (age, sex, and comorbidities), treatment information (treating facility, photodynamic diagnosis, early Mitomycin C (MMC) instillation), and pathological tumor parameters were assessed. First, we summarized our cohort by descriptive analyses. Second, we plotted the proportions of patients with guideline-adherence within selected subgroups and compared the distribution between the subgroups by using chi-squared tests. Third, we created a multivariable model to identify independent predictors of guideline-adherence.

Results

Most patients were male (78%) and median age was 75 years (range: 39-94 years). 44% had multifocal tumors, early Mitomycin C instillation was performed in 33%, repeat resection was performed in 78% of which 50% then had pT0 stage. Of 62% who underwent instillation therapy, 59% received BCG, while 41% received MMC or other agents. Quarterly cystoscopic follow-up was performed in 82%._x000D_ Overall, guideline-adherence was met in 57%. Patients aged below the median met all three adherence metrics more often compared to their counterparts above the median (66.7% vs. 46.3%; P=0.030). Similarly, men more frequently met adherence metrics compared to women (62.1% vs. 37.5%; P=0.038). More patients with multifocal tumors met all of the three adherence metrics (69.4% vs. 48.0%; P=0.050), as compared to those with unifocal lesions._x000D_ In univariable analyses, age, male sex, tumor multifocality, and early MMC instillation, were associated with guideline-adherence. In multivariable analyses, age (odds ratio [OR]=0.95; 95% confidence interval [CI]=0.91-0.99; P=0.013) and tumor multifocality (OR=2.48; 95% CI=1.01-6.11; P=0.048) held true as independent predictors of guideline-adherent treatment.

Conclusions

We found non-adherence in more than 1/3 of patients and treatment disparities among different age groups and according to tumor focality. While the underlying reasons are likely multifactorial, efforts should be put into evaluating this issue in larger samples and into trying to eradicate disadvantages in these patients at highest risk of recurrence.

Funding

None