Treatment Patterns and Outcomes in Localized Urothelial Carcinoma in Middle-Income Countries: A Multicenter Real-World Study.
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Castello Dias Carneiro André Paternò, Batista Elice Carneiro, Gomes Bugano Diogo Diniz, Corradi Rodrigo Guimarães, Panhoca Renato, Soler João Antonio, Carvalhal Eduardo, Ponte de Souza Andréa Lopes, Motke Bruna, Helber Henrique Alkalay, Sampaio Bruna Dos Santos, Monfardini Frederico, Lamas Assis Silvia Regina, Rodrigues Sant'Anna Viviane Aparecida, Prado Dos Santos Gustavo, Lopes da Silva Mayla, Duarte Flávia Miranda, Pereira Mariane, Fagundes Moia Diogo Duarte, Soares Ronaldo Vicente Pereira, Carneiro Arie, Perini Guilherme Fleury, Rizzo Luiz Vicente, Maluf Fernando Cotait
Аннотация
METHODS: This multicenter, retrospective, real-world study included patients with high-risk non-muscle-invasive (HR-NMIBC) and localized muscle-invasive bladder cancer (MIBC) diagnosed between 2017 and 2022 across nine cancer centers in a middle-income setting. Treatment data and clinical outcomes were collected from medical records and analyzed using descriptive statistics and Kaplan-Meier survival estimates.
RESULTS: Among 343 patients analyzed, 217 (63.3%) had HR-NMIBC, of whom only 29.5% received adjuvant Bacillus Calmette-Guérin (BCG), often substituted with intravesical gemcitabine because of supply shortages. BCG exposure was associated with superior overall and cancer-specific survival compared with non-BCG patients. In the muscle-invasive cohort (n = 126; 36.7%), cystectomy was performed in 48.4% and significantly improved survival. Perioperative chemotherapy remained limited, with only 39.3% receiving neoadjuvant therapy, and just one third receiving cisplatin-based regimens that conferred the greatest survival benefit.
CONCLUSION: This multicenter real-world study exposes major gaps in the management of localized UC in a middle-income setting. Limited access to BCG, perioperative chemotherapy, and cystectomy remain key barriers to guideline-concordant care, underscoring the urgent need for policy actions to improve treatment delivery and outcomes in comparable health care systems.