title: Use of adjuvant chemotherapy in radical cystectomy patients aged >65 years: a population-based study from the surveillance epidemiology and end results (SEER)-medicare database.
abstract: BACKGROUND
  The role of adjuvant chemotherapy (AC) within urothelial carcinoma of the urinary bladder (UCUB) patients after radical cystectomy (RC) is under debate. We assessed contemporary AC utilization rates. We also examined the rates of AC according to patient disease and sociodemographic characteristics.
  
  
  METHODS
  We relied on the SEER-Medicare database for non-organ-confined, muscle-invasive T2 N+ -T4a UCUB patients who underwent RC between 1991 and 2009 without neoadjuvant chemotherapy delivery. Multivariable logistic regression analyses tested predictors of AC use; T-stage, N-stage, year of diagnosis, age, gender, race, radiotherapy (RT) administration, marital urban and socioeconomic status, tumor grade and Charlson Comorbidity Index (CCI).
  
  
  RESULTS
  Overall, 2681 patients were identified. Of those, 667 (24.9%) received AC. The rate of AC were 21.4%, 23.5%, 24.6% and 29.9% over time (1991-1999 vs. 2000-2002 vs. 2003-2005 vs. 2006-2009) (P=0.002). In multivariable analyses stages pT2N+ (odds ratio (OR): 4.7; P<0.001) and pT3/4aN+ (OR: 4.0; P<0.001), year of diagnosis (OR: 1.9; P<0.001), RT (OR: 1.7; P<0.001), married status (OR: 1.4; P=0.001) and advanced age (OR: 0.3; P<0.001) were independent predictors of AC. Neither race nor CCI demonstrated significance.
  
  
  CONCLUSIONS
  In conclusion, we report lower than anticipated overall (24.9%) use of AC. Nonetheless, the rate increased from 13.6% (1991) to 24.1% (2009). Presence of lymph node invasion at RC regardless of T2 or T3/4a stage was the most important variable that increased AC use. Older and unmarried individuals were less likely to receive AC. AC rates were higher in T2N+ UCUB patients than in T3-T4a individuals.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada - j.schiffmann@klinikum-braunschweig.de.|Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany - j.schiffmann@klinikum-braunschweig.de.
authors.forename: Jonas
authors.initials: J
authors.lastname: Schiffmann
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.|Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy.|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 Center, Montreal, Canada.
authors.forename: Zeh
authors.initials: Z
authors.lastname: Tian
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.|Department of Urology, University of Montreal Health Center, Montreal, Canada.
authors.forename: Ioana
authors.initials: I
authors.lastname: Popa
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.|Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy.|Department of Urology, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Larcher
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 Urology, University of Montreal Health Center, Montreal, 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: Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy.|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 Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.affiliation: Department of Urology, University of Montreal Health Center, Montreal, Canada.
authors.forename: Fred
authors.initials: F
authors.lastname: Saad
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.|Department of Urology, University of Montreal Health Center, Montreal, Canada.
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D015653:Cystectomy / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy / Q000706:statistics & numerical data; D009367:Neoplasm Staging; D018426:SEER Program; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*