Survey of perioperative treatment in muscle-invasive bladder cancer using Japanese hospital-based claims database

PURPOSE: Urothelial carcinoma (UC) is a common malignant tumor of the urinary tract, with bladder cancer as the most frequent type. Radical cystectomy (RC) is the standard treatment for muscle-invasive bladder cancer (MIBC), and perioperative chemotherapy is recommended in addition to RC in guidelines. However, no established evidence defines the optimal regimen and number of cycles, and treatment varies by institution. Therefore, this study aimed to clarify perioperative treatment patterns for MIBC using a hospital-based claims database. METHODS: Patients with claims records for bladder cancer recorded during the case-identification window (2012–2020) were identified using the Medical Data Vision Co., Ltd. database. The database spans April 2008 to July 2021, enabling longitudinal assessment. Patient characteristics and prescribed perioperative chemotherapy regimens were analyzed. Factors associated with neoadjuvant chemotherapy (NAC) were examined using univariable analysis and an exploratory multivariable logistic regression model. RESULTS: Among 6,723 patients, 78.5% were men, with a median diagnosis age of 71 years. The treatment groups included 2,324 patients who received NAC, 598 who received adjuvant chemotherapy (AC), 364 who received NAC and AC, and 3,437 who underwent RC-only. NAC utilization rate increased over time (P for trend < 0.0001). Gemcitabine plus cisplatin was the most frequently administered regimen. Univariable analysis revealed an association between clinical stage 3 or higher and the NAC administration. In contrast, older age and comorbidities were associated with non-administration of NAC. Furthermore, the hospital size and cancer hospital designation influenced NAC administration. CONCLUSION: Perioperative chemotherapy utilization for MIBC has increased annually. Patient characteristics and treatment facility factors influence NAC administration.