title: Perioperative treatment and radical cystectomy for bladder cancer--a population based trend analysis of 10,338 patients in the Netherlands.
abstract: BACKGROUND
  In Europe, population-based data concerning perioperative treatment (PT) and radical cystectomy (RC) are lacking. We assessed temporal trends in PT (neoadjuvant chemotherapy [NAC], neoadjuvant radiotherapy [NAR], adjuvant chemotherapy [AC], adjuvant radiotherapy [AR]) and RC in the Netherlands and identified patients' and hospital characteristics associated with PT.
  
  
  METHODS
  This nationwide, retrospective, population-based study included cTa/is, T1-4, N0-3, M0-1 bladder cancer patients from the Netherlands Cancer Registry who underwent RC with curative intent between 1995 and 2013. PT-administration over time was compared with chi-square tests. Multivariable logistic regression analyses were performed to identify characteristics associated with PT usage. The sub-groups cT2-4N0M0 and cT2-4, N0 or NX, M0 or MX were separately analysed.
  
  
  RESULTS
  In total, 10,338 patients met inclusion criteria. Eighty-six percent did not receive PT, 7.0% received NAC (or induction chemotherapy [IC]), 3.2% NAR, 1.8% AC, and 2.1% AR. NAC usage increased from 0.6% in 1995 to 21% in 2013 (p < 0.001), application of NAR decreased from 15% to 0.4% (p < 0.001). Usage of AC and AR in 2013 was <1.5%. Comparable temporal trends were found in 6032 patients staged cT2-4N0M0. Multivariable logistic regression analysis revealed that younger age, ≥ cT3, ≥ cN1 and treatment in academic/teaching hospitals were associated with NAC or IC (all p < 0.05).
  
  
  CONCLUSIONS
  The increase in NAC administration in the Netherlands reflects a slow but steady adoption of evidence-based guidelines over the last two decades. Considerable variability in patients' and hospital characteristics in the likelihood of receiving NAC exists. Conversely, NAR, AR and AC are hardly administered anymore.
authors.affiliation: Department of Surgical Oncology, Division of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Tom J N
authors.initials: TJN
authors.lastname: Hermans
authors.affiliation: Department of Surgical Oncology, Division of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Elisabeth E
authors.initials: EE
authors.lastname: Fransen van de Putte
authors.affiliation: Department of Surgical Oncology, Division of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Simon
authors.initials: S
authors.lastname: Horenblas
authors.affiliation: Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands; Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.
authors.forename: Valery
authors.initials: V
authors.lastname: Lemmens
authors.affiliation: Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands; Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Katja
authors.initials: K
authors.lastname: Aben
authors.affiliation: Department of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Michiel S
authors.initials: MS
authors.lastname: van der Heijden
authors.affiliation: Department of Medical Oncology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.
authors.forename: Laurens V
authors.initials: LV
authors.lastname: Beerepoot
authors.affiliation: Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.
authors.forename: Rob H
authors.initials: RH
authors.lastname: Verhoeven
authors.affiliation: Department of Surgical Oncology, Division of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. Electronic address: basvanrhijn@hotmail.com.
authors.forename: Bas W G
authors.initials: BWG
authors.lastname: van Rhijn
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D015653:Cystectomy / Q000639:trends*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy / Q000639:trends*; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D009426:Netherlands / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000639:trends*; D018714:Radiotherapy, Adjuvant; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D055815:Young Adult
keywords: Adjuvant; Bladder; Cancer; Chemotherapy; Cystectomy; Neoadjuvant; Radiotherapy