title: Suboptimal use of neoadjuvant chemotherapy in radical cystectomy patients: A population-based study.
abstract: BACKGROUND
  We aimed to assess contemporary rates of neoadjuvant chemotherapy (NC) use.
  
  
  METHODS
  We relied on the Surveillance, Epidemiology and End Results (SEER)-Medicare database for non-metastatic, muscle-invasive (T2-T4a) urothelial carcinoma of the urinary bladder (UCUB) patients who underwent radical cystectomy (RC) between 1991 and 2009. Multivariable logistic regression analyses tested predictors of NC use, such as: T-stage, N-stage, year of diagnosis, age at diagnosis, gender, race, use of radiotherapy (RT), marital status, urban status, socioeconomic status, tumour grade, and Charlson comorbidity index (CCI).
  
  
  RESULTS
  Overall, 5207 patients treated with RC were identified. Of those, 332 (6.4%) received NC. The rate of NC increased over time from 6.1% (1991) to 15.0% (2009) (p<0.001). In multivariable analyses, year of diagnosis (odds ratio [OR]: 4.7; p<0.001), lower T-stage (T3 vs. T2: OR: 0.7; p=0.003), married status (OR: 1.5; p=0.006), and younger age at diagnosis (≥80 vs. 66-69: OR: 0.6; p=0.006) were associated with a higher odds of NC; all represented independent predictors of NC use. Neither race nor CCI demonstrated statistical significance.
  
  
  CONCLUSIONS
  We reported lower than anticipated overall (6.4%) use of NC. Nonetheless, the rate increased from 6.1% (1991) to 15.0% (2009). Older and unmarried individuals were less likely to receive NC. NC rates were higher in T2 UCUB patients. Some of the observed discrepancies, such as lower use in unmarried individuals, may require correction. Better adherence to guidelines should be encouraged and implemented, especially based on the confirmed benefits of NC according to randomized, controlled trials. The study is limited by a retrospective design and limited variables.
authors.affiliation: Martini-Clinic, Prostate Cancer Centre, University Medical Centre Hamburg-Eppendorf, Germany;; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada;
authors.forename: Jonas
authors.initials: J
authors.lastname: Schiffmann
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada;
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada;; Department of Urology, Vita-Salute, San Raffaele University, Milan, Italy;
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gandaglia
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada;
authors.forename: Zhe
authors.initials: Z
authors.lastname: Tian
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada;
authors.forename: Ioana
authors.initials: I
authors.lastname: Popa
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada;; Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy;
authors.forename: Alessandro
authors.initials: A
authors.lastname: Larcher
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada;
authors.forename: Malek
authors.initials: M
authors.lastname: Meskawi
authors.affiliation: Department of Urology, Vita-Salute, San Raffaele University, Milan, Italy;
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.affiliation: Department of Surgery, University of Montreal, Montreal, QC, Canada;
authors.forename: Michael
authors.initials: M
authors.lastname: McCormack
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria;
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.affiliation: Department of Urology, Vita-Salute, San Raffaele University, Milan, Italy;
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: Martini-Clinic, Prostate Cancer Centre, University Medical Centre Hamburg-Eppendorf, Germany;
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.affiliation: Department of Urology, University of Montreal, Montreal, QC, Canada.
authors.forename: Fred
authors.initials: F
authors.lastname: Saad
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada;; Department of Urology, University of Montreal, Montreal, QC, Canada.
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz