Contemporary Trends of Systemic Neoadjuvant and Adjuvant Intravesical Chemotherapy in Patients With Upper Tract Urothelial Carcinomas Undergoing Minimally Invasive or Open Radical Nephroureterectomy: Analysis of US Claims on Perioperative Outcomes and Health Care Costs

被引：19

作者：

Del Giudice, Francesco ^{[1
,2
]}

van Uem, Stefanie ^{[2
]}

Li, Shufeng ^{[2
]}

Vilson, Fernandino L. ^{[2
]}

Sciarra, Alessandro ^{[1
]}

Salciccia, Stefano ^{[1
]}

Busetto, Gian Maria ^{[3
]}

Maggi, Martina ^{[1
]}

Tiberia, Letizia ^{[1
]}

Viscuso, Pietro ^{[1
]}

Canale, Vittorio ^{[1
]}

Panebianco, Valeria ^{[4
]}

Pecoraro, Martina ^{[4
]}

Ferro, Matteo ^{[5
]}

Moschini, Marco ^{[6
,7
]}

Krajewski, Wojciech ^{[8
]}

D'Andrea, David ^{[9
]}

Cacciamani, Giovanni E. ^{[10
]}

Mari, Andrea ^{[11
]}

Soria, Francesco ^{[12
]}

Porpiglia, Francesco ^{[13
]}

Fiori, Cristian ^{[13
]}

Amparore, Daniele ^{[13
]}

Checcucci, Enrico ^{[13
]}

Autorino, Riccardo ^{[14
]}

De Berardinis, Ettore ^{[1
]}

Chung, Benjamin, I ^{[2
]}

机构：

[1] Sapienza Univ Rome, Dept Maternal Infant & Urol Sci, Policlin Umberto I Hosp, Viale Policlin 155, I-00161 Rome, Italy

[2] Stanford Med Ctr, Dept Urol, Stanford, CA USA

[3] Univ Foggia, Dept Urol & Renal Transplantat, Policlin Riuniti, Foggia, Italy

[4] Sapienza Univ, Dept Radiol Sci Oncol & Pathol, Policlin Umberto I, Rome, Italy

[5] European Inst Oncol IRCCS, Dept Urol, IEO, Milan, Italy

[6] Luzerner Kantonsspital, Dept Urol, Luzern, Switzerland

[7] IRCCS Osped San Raffaele, Unit Urol, Urol Res Inst, Div Expt Oncol, Milan, Italy

[8] Wroclaw Med Univ, Dept Minimally Invas & Robot Urol, Univ Ctr Excellence Urol, PL-50556 Wroclaw, Poland

[9] Med Univ Vienna, Vienna Gen Hosp, Comprehens Canc Ctr, Dept Urol, Vienna, Austria

[10] Univ Southern Calif, USC Inst Urol & Catherine & Joseph Aresty, Dept Urol, Keck Sch Med, Los Angeles, CA 90007 USA

[11] Univ Florence, Careggi Univ Hosp, Dept Expt & Clin Med, Unit Oncol Minimally Invas Urol & Androl, Florence, Italy

[12] Univ Turin, Molinette Hosp, Dept Urol, Turin, Italy

[13] Univ Turin, San Luigi Hosp, Sch Med, Div Urol,Dept Oncol, Turin, Italy

[14] VCU Hlth Syst, Div Urol, Richmond, VA USA

来源：

CLINICAL GENITOURINARY CANCER | 2022年 / 20卷 / 02期

关键词：

Minimally invasive nephroureterectomy; Neoadjuvant systemic chemotherapy; UTUC; Robotic-assisted nephroureterectomy; Laparoscopic-assisted nephroureterectomy;

D O I：

10.1016/j.clgc.2021.11.016

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Most of the radical interventions have shifted towards more minimally invasive approaches such as laparoscopic or robotic assisted surgeries to treat UTUC. While these paradigm shifts have led to reduction of morbidity and perioperative health-care related costs over the past 15 years, our patient cohort did not receive NAC and PIC. Introduction: New evidence indicates that minimally invasive surgery (MIS) (laparoscopic or robotic-assisted [LNU, RANU]) reaches oncologIc equivalence compared with Open Radical Nephroureterectomy (ORNU) for high-risk upper-tract urothelial carcinoma (UTUC). Recently, European Association of Urology (EAU) Guidelines suggested implementing neoadjuvant chemotherapy (NAC) to standard treatment to improve oncologic outcomes of high-risk UTUC. We aimed (1) To explore contemporary trends of MIS for RNU in the United States and to compare perioperative outcomes and costs with that of ORNU. (2) To determine the trends of NAC and postoperative intravesical chemotherapy (PIC) administration for high-risk UTUC and to assess their contribution to perioperative outcomes and costs. Patients and Methods: The Optum Clinformatics Data Mart de-identified database was queried from 2003 to 2018 to retrospectivety examine patients who had undergone LNU/RANU or ORNU with or without NAC and PIC. We evaluated temporal adoption trends, complications, and health care cost analyses. We obtained descriptive statistics and utilized muitivariable regression modeling to assess outcomes. Results: A total of n = 492 ORNU and n = 1618 LNU/RANU procedures were reviewed. The MIS approach was associated with a statistically significant lower risk of intraoperative complications (adjusted Odds Ratio [aOR], 0.48.95% CI:0.24-0.96), risk of hospitalization costs (aOR: 0.62, 95% CI:0A9-0.78), and shorter hospital stay (aOR: 0.20, 95% CI:0.15-0.26) when compared to ORNU. Overall, adoption of NAC and PIC accounted for only n = 81 and n < 37 cases respectively. The implementation of NAG and higher number of cycles were associated with an increased probability of any complication rate (aOR: 2.06, 95% CI:1.26-3.36) and hospital costs (aOR: 2.12, 95% CI:1.33-3.38). Conclusion: MIS has become the approach of choice for RNU in the US. Although recommended by guidelines, neither NAG nor postoperative bladder instillation of chemotherapy has been routinely incorporated into the clinical practice of patients with UTUC. (C) 2021 Elsevier Inc. All rights reserved.

引用

页码：198.e1 / 198.e9

页数：9

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