Evaluating Guideline Adherence for T1 Bladder Cancer Treatment and Surveillance: A Retrospective German Multicenter Observation

Abstract

Introduction: To mirror guideline-adherence for pT1 bladder cancer treatment in Northern Germany. Materials and Methods: Overall, 111 patients with pT1 diagnosis were treated at 4 institutions. Guideline-adherence was defined as repeat resection, instillation, and quarterly cystoscopy. Patient characteristics and pathological parameters were assessed. We summarized patients using descriptive analyses and evaluated guideline-adherence within selected subgroups. We created a multivariable model to identify predictors of guideline-adherence. Results: Median age was 75 years (range 39–94 years), multifocal tumors were found in 44.1%, early instillation was performed in 33.3%, and repeat resection was performed in 77.5%. Of 62.2% who underwent instillation, 59.4% received BCG, while 40.6% received Mitomycin C or other agents. Cystoscopic follow-up was performed in 81.8%. Guideline-adherence was met in 56.8%. Patients aged below the median met adherence metrics more often compared to those above the median (66.7 vs. 46.3%; p = 0.030). Men more frequently met adherence metrics compared to women (62.1 vs. 37.5%; p = 0.038). More patients with multifocal tumors met all 3 adherence metrics (69.4 vs. 48.0%; p = 0.050), as compared to those with unifocal lesions. In multivariable analyses, age-adjusted comorbidity (OR 0.75; 95% CI 0.59–0.94; p = 0.011) and multifocality (OR 2.62; 95% CI 1.09–6.27; p = 0.031) were predictors of guideline-adherence. Conclusions: We found non-adherence in more than one-third of patients and disparities among patients of different age and according to tumor focality. Larger samples and prospective studies are needed to delineate and eradicate treatment disadvantages in these high-risk patients.

Treatment Outcomes of High-Risk Non-Muscle Invasive Bladder Cancer (HR-NMIBC) in Real-World Evidence (RWE) Studies: Systematic Literature Review (SLR)

“…Median follow-up for OS ranged from 23 to 130 months across the 21 studies that reported this. 23,27,28,32,33,37,47,49,51,58,66,69,70,74,83,[86][87][88][97][98][99] Likewise, there was no evident trend in survival outcomes with increasing duration of follow-up. Notably, one study by Gordon et al reported the lowest percentage of patients who were alive at follow-up (9.8%) out of the 21 studies, which was seen in patients with HR-NMIBC who did not undergo re-TURBT after a median follow-up period of 50 months.…”

“…16,17,27,31,33,34,36,37,42,45,46,[50][51][52]54,59,63,65,68,69,72,74,75,77 Twelve studies reported the use of mitomycin C in high-risk patients. 23,28,30,46,48,64,66,70,72,[79][80][81] Treatment rates ranged from 2% to 53% in 9 studies, with few studies reporting its use in all patients (rate of 100% in 3 studies). In 7 of the 11 studies (64%), mitomycin C 23,28,46,48,64,66,72 Adjuvant and intravesical chemotherapy in HR-NMIBC (not including mitomycin C) were rarely used and reported in a small number of studies (4 55,58,66,67 and 8, 23,28,32,33,51,70,…”

“…23,28,30,46,48,64,66,70,72,[79][80][81] Treatment rates ranged from 2% to 53% in 9 studies, with few studies reporting its use in all patients (rate of 100% in 3 studies). In 7 of the 11 studies (64%), mitomycin C 23,28,46,48,64,66,72 Adjuvant and intravesical chemotherapy in HR-NMIBC (not including mitomycin C) were rarely used and reported in a small number of studies (4 55,58,66,67 and 8, 23,28,32,33,51,70,74,82 respectively). The proportion of highrisk patients treated with adjuvant chemotherapy in reporting studies ranged from 2% to 19%, and 4% to 34% for intravesical chemotherapy.…”

“…37,42,58 The use of re-TURBT in patients with HR-NMIBC was reported in 43 studies. 16,[18][19][20][21][22][23][27][28][29][30][31][32][33]37,[41][42][43]45,47,[49][50][51][52][53][54][55][56]58,64,69,70,74,77,78,[83][84][85][86][87][88][89][90] Across 27 studies, the use of this procedure varied from 15% to 82%, 16,18,[20][21][22][30]…”

“…The median follow-up for CSS ranged from 12 to 130 months across 30 studies that reported CSS at follow-up.- 17,[20][21][22][23]27,28,32,33,[40][41][42]44,46,47,49,51,52,66,68,70,74,83,[86][87][88][97][98][99]110 There was no observed trend in the proportion of HR-NMIBC patients dying due to cancer (CSS) with increasing length of follow-up (Figure 5A). Median follow-up for OS ranged from 23 to 130 months across the 21 studies that reported this.…”