PD62-06 NEOADJUVANT CHEMOTHERAPY FOR ELDERLY PATIENTS WITH LOCALLY ADVANCED OR EARLY NODAL DISEASE: ARE WE DOING ENOUGH? (2017)

You have accessJournal of UrologyBladder Cancer: Invasive VI1 Apr 2017PD62-06 NEOADJUVANT CHEMOTHERAPY FOR ELDERLY PATIENTS WITH LOCALLY ADVANCED OR EARLY NODAL DISEASE: ARE WE DOING ENOUGH? Andres Correa, Elizabeth Handorf, Benjamin Ristau, Haifler Haifler, Shreyas Joshi, Robert Uzzo, Rosalia Viterbo, Richard Greenberg, David Chen, Alexander Kutikov, Daniel Geynisman, and Marc Smaldone Andres CorreaAndres Correa More articles by this author , Elizabeth HandorfElizabeth Handorf More articles by this author , Benjamin RistauBenjamin Ristau More articles by this author , Haifler HaiflerHaifler Haifler More articles by this author , Shreyas JoshiShreyas Joshi More articles by this author , Robert UzzoRobert Uzzo More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , David ChenDavid Chen More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Daniel GeynismanDaniel Geynisman More articles by this author , and Marc SmaldoneMarc Smaldone More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2778AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES 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. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1195 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Andres Correa More articles by this author Elizabeth Handorf More articles by this author Benjamin Ristau More articles by this author Haifler Haifler More articles by this author Shreyas Joshi More articles by this author Robert Uzzo More articles by this author Rosalia Viterbo More articles by this author Richard Greenberg More articles by this author David Chen More articles by this author Alexander Kutikov More articles by this author Daniel Geynisman More articles by this author Marc Smaldone More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...