Introduction

The administration of neoadjuvant chemotherapy (NAC) for patients with muscle invasive urothelial carcinoma improves overall survival and is a category 1 NCCN recommendation. Recent reports have shown that the survival benefit may be greater in patients with locally advance disease and nodal involvement. Here we aim to assess the NAC administration trends in patients with locally advanced and low stage nodal disease using a large national tumor registry.

Methods

Patients treated for muscle invasive urothelial carcinoma were selected from the National Cancer Data Base. Patients with clinical stage T2-T4 and low stage nodal disease (N0-N2), treated between 2004 and 2014, where included in the study. Patients who underwent chemotherapy as the only treatment where excluded from the analysis. A multivariate analysis was constructed to identify factors that affected administration of NAC. Covariates included in the model were clinical stage, age, race, sex, insurance status, income, Charlson comorbidity index, pathological stage, demographic location, facility location, and diagnosis year.

Results

A total of 19,299 patients met inclusion criteria for the study. NAC utilization increased over the study period with 35.6% of patients receiving NAC in 2014 compared to 10.1% in 2004. Decreasing NAC utilization was noted with increasing age (< 65 years: 28.0%; 65-74 years: 23.9%; ≥75 years: 12.3%, p<0.001). On multivariate analysis age, clinical stage and patient age were found to be significantly associated with administration of NAC. Increasing clinical stage and early nodal disease was found to be associated with an increase in the administration of NAC, using cT2N0 as a reference, the likelihood of NAC administration of T3N0 and T4N0 and Tany/N1-2 was 1.31 (95% CI 1.14 to 1.50) and 1.63 (95% CI 1.43 and 1.87) respectively (p< 0.001, both). Increasing age was associated with a decrease in the use of NAC, using <65 years as a reference, the likelihood of NAC administration for patients 65-74 years and ≥75 years was .89 (95% 0.82 to 0.91) and 0.39 (95% CI 0.34 to 0.44), respectively (p=0.32 and p< 0.001). On interaction analysis between age and clinical stage, the likelihood of receiving NAC still increased with increasing clinical stage in patients < 65 to 74 years old but this effect was non-existent in patients 75 years or older.

Conclusions

Although the administration of NAC has increased over the last 10 years, the use of NAC in septa and octogenarians remains low; even, in those presenting with advance stage and early nodal disease.

Funding

none