Treatment Patterns and Outcomes in Localized Urothelial Carcinoma in Middle-Income Countries: A Multicenter Real-World Study.
Disparities in health care access and resource availability in middle-income countries often lead to suboptimal management of localized bladder urothelial carcinoma (UC). However, real-world data describing treatment patterns and outcomes in these settings remain limited.
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.
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.
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.
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.
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.
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.
Authors
Castello Dias Carneiro Castello Dias Carneiro, Batista Batista, Gomes Bugano Gomes Bugano, Corradi Corradi, Panhoca Panhoca, Soler Soler, Carvalhal Carvalhal, Ponte de Souza Ponte de Souza, Motke Motke, Helber Helber, Sampaio Sampaio, Monfardini Monfardini, Lamas Assis Lamas Assis, Rodrigues Sant'Anna Rodrigues Sant'Anna, Prado Dos Santos Prado Dos Santos, Lopes da Silva Lopes da Silva, Duarte Duarte, Pereira Pereira, Fagundes Moia Fagundes Moia, Soares Soares, Carneiro Carneiro, Perini Perini, Rizzo Rizzo, Maluf Maluf
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