Urology practice · 2026
National Patterns and Predictors of Perioperative Intravesical Chemotherapy Use Following Nephroureterectomy for Upper Tract Urothelial Carcinoma.
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Wang Shu, Blum Kyle A, Iranmahboub Parsa, Xu Helen, Dave Priya, Scherr Douglas S
Аннотация
INTRODUCTION: Intravesical chemotherapy (IC) administered perioperatively after nephroureterectomy (NUx) for upper tract urothelial carcinoma reduces intravesical recurrence based on 2 randomized trials and is endorsed by contemporary practice guidelines. However, real-world adoption of this intervention remains poorly defined. We evaluated national utilization trends and identified predictors of perioperative IC use after NUx.
METHODS: Using the National Cancer Database, we identified patients with nonmetastatic upper tract urothelial carcinoma who underwent NUx between 2013 and 2022. Perioperative IC was defined as chemotherapy administered within 48 hours of surgery. Temporal trends were assessed using the Cochran-Armitage test. Multivariable logistic regression was used to identify factors independently associated with IC receipt.
RESULTS: Among 14,808 eligible patients, only 1032 (7.0%) received perioperative IC. Utilization increased significantly over time, from 1.1% in 2013 to 16.6% in 2022 (P < .001). On multivariable analysis, treatment at an academic (odds ratio [OR] 2.47, 95% CI 2.09-2.91) or comprehensive cancer program (OR 2.24, 95% CI 1.86-2.69), later year of diagnosis (OR 1.37 per year, 95% CI 1.33-1.41), and ureteral tumor location (OR 1.22, 95% CI 1.06-1.40) were associated with higher odds of IC use. Hispanic ethnicity (OR 0.39, 95% CI 0.26-0.59), higher clinical T stage, and open surgical approach were associated with significantly lower odds of IC receipt.
CONCLUSIONS: Despite level 1 evidence and guideline endorsement, perioperative IC after NUx remains infrequently used in the United States. Persistent disparities in adoption highlight a substantial evidence-to-practice gap and underscore opportunities for targeted implementation strategies to improve equitable delivery of guideline-supported care.
METHODS: Using the National Cancer Database, we identified patients with nonmetastatic upper tract urothelial carcinoma who underwent NUx between 2013 and 2022. Perioperative IC was defined as chemotherapy administered within 48 hours of surgery. Temporal trends were assessed using the Cochran-Armitage test. Multivariable logistic regression was used to identify factors independently associated with IC receipt.
RESULTS: Among 14,808 eligible patients, only 1032 (7.0%) received perioperative IC. Utilization increased significantly over time, from 1.1% in 2013 to 16.6% in 2022 (P < .001). On multivariable analysis, treatment at an academic (odds ratio [OR] 2.47, 95% CI 2.09-2.91) or comprehensive cancer program (OR 2.24, 95% CI 1.86-2.69), later year of diagnosis (OR 1.37 per year, 95% CI 1.33-1.41), and ureteral tumor location (OR 1.22, 95% CI 1.06-1.40) were associated with higher odds of IC use. Hispanic ethnicity (OR 0.39, 95% CI 0.26-0.59), higher clinical T stage, and open surgical approach were associated with significantly lower odds of IC receipt.
CONCLUSIONS: Despite level 1 evidence and guideline endorsement, perioperative IC after NUx remains infrequently used in the United States. Persistent disparities in adoption highlight a substantial evidence-to-practice gap and underscore opportunities for targeted implementation strategies to improve equitable delivery of guideline-supported care.