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

To mirror guideline-adherence for pT1 bladder cancer treatment in Northern Germany.

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.

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.

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.

Urologia internationalis. 2018 Sep 20 [Epub ahead of print]

Malte W Vetterlein, Philipp Gild, Phillip Marks, Julia Roschinski, Ousman Doh, Wolfgang Höppner, Walter Wagner, Hendrik Isbarn, Franziska Büscheck, Guido Sauter, Roland Dahlem, Armin Soave, Margit Fisch, Michael Rink

Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Department of Urology, Regio Medical Center Elmshorn, Elmshorn, Germany., Department of Urology, Itzehoe Medical Center, Itzehoe, Germany., Department of Urology, Bundeswehr Medical Center Hamburg, Hamburg, Germany., Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.