title: Utilization of perioperative systemic chemotherapy in upper tract urothelial carcinoma.
abstract: Evidence for the use of perioperative chemotherapy (PC) in upper tract urothelial carcinoma (UTUC) is largely derived from level I evidence for invasive urothelial carcinoma of the bladder (UCB). There has been an increase in PC for urothelial carcinoma of the bladder, as it has disseminated into clinical practice. Therefore, we sought to not only analyze trends in the utilization of PC in UTUC, but also assess factors associated with its use in a large cancer registry database.
  
  
  
  The National Cancer Database was queried for patients with UTUC who underwent extirpative surgery from 2004 to 2013. Predictors of receiving PC were identified using univariate and multivariate logistic regression. Temporal trends in the utilization of PC were also analyzed using a general analysis of variance linear model.
  
  
  
  From 2004 to 2013, there was significant increase in PC for UTUC from 9.6% to 13.8% (P = 0.0003). Neoadjuvant chemotherapy increased from 0.7% to 2.1% (P = 0.0018), whereas adjuvant chemotherapy remained relatively stable at 11.3%. Significant predictors of receiving PC on multivariate analysis were private insurance, ureter as the primary site, poorly differentiated and undifferentiated grade, lymphovascular invasion, positive margins, clinical T3 or T4 disease, nodal metastasis, and reporting from an academic research program. Patients who were≥70 years old,>50 miles to treatment center, had tumor in the kidney, or had an increased Charlson-Deyo Score were significantly less likely to receive PC.
  
  
  
  Over the time period studied, there has been an increase in the use of PC, primarily from increased administration of neoadjuvant chemotherapy. Its use is mostly associated with advanced pathologic characteristics. The study also highlights key demographic and socioeconomic differences that can help identify barriers to receiving PC and aid in making improvements in delivery of health care to patients with UTUC.
authors.affiliation: Division of Urology, VA Long Beach Healthcare System, Long Beach, CA. Electronic address: greg.gin@va.gov.
authors.forename: Greg E
authors.initials: GE
authors.lastname: Gin
authors.affiliation: Division of Biostatistics, City of Hope National Medical Center, Duarte, CA.
authors.forename: Nora H
authors.initials: NH
authors.lastname: Ruel
authors.affiliation: Northeast Medical Group Urology, Yale New Haven Health, CT.
authors.forename: Steven V
authors.initials: SV
authors.lastname: Kardos
authors.affiliation: Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: John P
authors.initials: JP
authors.lastname: Sfakianos
authors.affiliation: Division of Urology, VA Long Beach Healthcare System, Long Beach, CA; Department of Urology, UC Irvine Medical Center, Orange, CA.
authors.forename: Edward
authors.initials: E
authors.lastname: Uchio
authors.affiliation: Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA.
authors.forename: Clayton S
authors.initials: CS
authors.lastname: Lau
authors.affiliation: Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA.
authors.forename: Bertram E
authors.initials: BE
authors.lastname: Yuh
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D017024:Chemotherapy, Adjuvant / Q000639:trends; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000639:trends; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D059035:Perioperative Period; D012042:Registries; D014481:United States; D014516:Ureteral Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
keywords: Chemotherapy, adjuvant; Transitional cell carcinomas; Trends; Utilization