Login to Access Video or Poster Abstract: MP15-06
Sources of Funding: UC Davis academic senate

Introduction

Non-muscle invasive bladder cancer (NMIBC) is in need of markers of quality care and is a disease where quality improvement initiatives have significant potential to improve patient outcomes. Current guidelines support re-resection for all patients diagnosed with high grade (HG) or T1 tumors, yet no current studies have evaluated practice patterns and uptake of re-resection at the population-level. We sought to characterize rates of utilization and assess predictors of uptake of this practice as an initial step in developing quality improvement initiatives in NMIBC._x000D_

Methods

Incident cases of HG or T1 NMIBC diagnosed between 2005 and 2012 were identified from the California Cancer Registry and linked to hospital records of the Office of Statewide Health Planning and Development. Tumor, patient, and hospital characteristics were included in the analysis. Incidence rates of re-resection were reported and defined as a second TURBT occurring between 14-42 days of initial resection. Multivariable logistic regression analysis was utilized to assess predictors of undergoing re-resection. Inverse propensity weighting and multivariable Cox proportional hazards regression models were utilized to assess predictors of recurrence and survival (overall and cancer-specific). _x000D_

Results

The final cohort consisted of 8,468 patients with HG or T1 NMIBC diagnosed in California between 2005 and 2012. The overall incidence rate of re-resection was 8.9%, with increases observed over time: 5.2% (2005-2006) to 11.8% (2011-2012). The strongest predictors of undergoing re-resection in multivariable analysis were HG disease (OR 2.99, CI 2.46 - 3.63), tumors >5cm (OR 1.72, 1.23 - 2.39), and year of diagnosis (OR 1.28, 1.20 - 1.38 at 2 year increments). Increasing age was associated with decreased likelihood of re-resection (OR 0.74, 0.69 - 0.80 at 10 year increments). Independent predictors of recurrence included HGT1 tumor (HR 1.28, 1.10 - 1.49). Re-resection was not associated with better overall survival (HR 0.80, 0.62 – 1.05) or bladder cancer specific survival (HR 0.83, 0.54 - 1.27). _x000D_

Conclusions

Rates of re-resection for HG or T1 tumors remain unacceptably low for this accepted standard practice and have demonstrated only modest improvement in recent years. Such underutilization represents a reminder of the need for better mechanisms to translate guideline recommendations into clinical practice in bladder cancer. There remains significant room for improvement in managing this disease and improving patient outcomes._x000D_

Funding

UC Davis academic senate