Intravesical chemotherapy (IC) administered perioperatively after nephroureterectomy (NUx) for upper tract urothelial carcinoma (UTUC) reduces intravesical recurrence based on two 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 following NUx.
Using the National Cancer Database, we identified patients with non-metastatic UTUC 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.
Among 14,808 eligible patients, only 1,032 (7.0%) received perioperative IC. Utilization increased significantly over time, from 1.1% in 2013 to 16.6% in 2022 (p<0.001). On multivariable analysis, treatment at an academic (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.
Despite level 1 evidence and guideline endorsement, perioperative intravesical chemotherapy after nephroureterectomy 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.
Urology practice. 2026 Jul 02 [Epub ahead of print]
Shu Wang, Kyle A Blum, Parsa Iranmahboub, Helen Xu, Priya Dave, Douglas S Scherr
Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.