Perioperatieve behandelingen en radicale cystectomie voor blaaskanker. Een trendanalyse over 10.338 patiënten in Nederland

Background: In Europe, population-based data concerning perioperative treatment (PT) and radical cystectomy (RC) are lacking. We assessed temporal tends in PT (neoadjuvant chemotherapy (NAC), neoadjuvant radiotherapy (NAR), adjuvant chemotherapy (AC), adjuvant radiotherapy (AR)) and RC in the Netherlands and identified patients’ and hospital characteristics associated with PT. Methods: This nationwide, retrospective, population-based study included cTa/is, T1–4, N0–3, M0–1 bladder cancer (BC) patients from the Netherlands Cancer Registry who underwent RC with curative intent between 1995 and 2013. PT-administration over time was compared with chi-square tests. Multivariable logistic regression analyses were performed to identify characteristics associated with PT usage. The sub-groups cT2–4N0M0 and cT2–4, N0 or Nx, M0 or Mx were separately analyzed. Results: In total, 10,338 patients met inclusion criteria. 86 % did not receive PT, 7.0 % received NAC (or induction chemotherapy (IC)), 3.2 % NAR, 1.8 % AC, and 2.1 % AR. NAC usage increased from 0.6 % in 1995 to 21.2 % in 2013 (p < 0.001), application of NAR decreased from 15.1 % to 0.4 % (p < 0.001). Usage of AC and AR in 2013 was <1.5 %. Comparable temporal trends were found in 6,032 patients staged cT2–4N0M0. Multivariable logistic regression analysis revealed that younger age, ≥cT3, ≥cN1 and treatment in academic/teaching hospitals were associated with NAC or IC (all p < 0.05). Conclusions: The increase in NAC administration in the Netherlands reflects a slow but steady adoption of evidence based guidelines over the last two decades. Considerable variability in patients’ and hospital characteristics in the likelihood of receiving NAC exists. Conversely, NAR, AR and AC are hardly administered anymore.