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Trends in the Use of Chemotherapy before and after Radical Cystectomy in Patients with Muscle-invasive Bladder Cancer in Korea

Authors
Kim, Sung HanSeo, Ho KyungShin, Hee ChulChang, Sung JaYun, SooinJoo, JungnamKu, Ja HyeonKim, Hyung SukJeon, Hwang GyunJeong, Byong ChangJeong, In GabKang, Seok HoHong, Bumsik
Issue Date
8월-2015
Publisher
KOREAN ACAD MEDICAL SCIENCES
Keywords
Urinary Bladder Neoplasms; Neoadjuvant Therapy; Adjuvant; Chemotherapy; Cystectomy
Citation
JOURNAL OF KOREAN MEDICAL SCIENCE, v.30, no.8, pp.1150 - 1156
Indexed
SCIE
SCOPUS
KCI
Journal Title
JOURNAL OF KOREAN MEDICAL SCIENCE
Volume
30
Number
8
Start Page
1150
End Page
1156
URI
https://scholar.korea.ac.kr/handle/2021.sw.korea/92865
DOI
10.3346/jkms.2015.30.8.1150
ISSN
1011-8934
Abstract
We investigated trends in perioperative chemotherapy use, and determined factors associated with neoadjuvant chemotherapy (NAC) and adjuvant chemotherapy (AC) use in Korean patients with muscle-invasive bladder cancer (MIBC). We recruited 1,324 patients who had MIBC without nodal invasion or metastases and had undergone radical cystectomies (RC) between 2003 and 2013. The study's cut-off time for AC was three months after surgery, and the study's timespan was divided into three periods based on NAC use, namely, 2003-2005, 2006-2009, and 2010-2013. Complete remission was defined as histologically confirmed T0N0M0 after RC. NAC and AC were administered to 7.3% and 18.1% of the patients, respectively. The median time interval between completing NAC and undergoing RC was 32 days and the mean number of cycles was 3.2. The median time interval between RC and AC was 43 days and the mean number of cycles was 4.1. Gemcitabine and cisplatin were most frequently used in combination for NAC (49.0%) and AC (74.9%). NAC use increased significantly from 4.6% between 2003 and 2005 to 8.4% between 2010 and 2013 (P<0.05), but AC use did not increase. Only 1.9% of patients received NAC and AC. Complete remission after NAC was achieved in 12 patients (12.5%). Multivariable modeling revealed that an advanced age, the earliest time period analyzed, and clinical tumor stage <= cT2 bladder cancer were negatively associated with NAC use (P < 0.05). While NAC use has slowly increased over time, it remains an underutilized therapeutic approach in Korean clinical practice.
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