3 research outputs found
Treatment trends for muscle-invasive bladder cancer in Germany from 2006 to 2019
Purpose:
To examine national treatment trends of muscle-invasive bladder cancer (MIBC) in Germany with a special focus on radical cystectomy (RC).
Patients and methods:
Population-based data were derived from the nationwide hospital billing database of the German Federal Statistical Office and institution-related information from the reimbursement.INFO tool based on hospitalsâ quality reports from 2006 to 2019. Additionally, we used the German National Center for Cancer Registry data to analyze all cases of bladder cancer with stageââ„âT2 who received RC, chemotherapy, radiation therapy or a combination from 2006 to 2017.
Results:
The annual number of RC cases in Germany increased by 28% from 5627 cases in 2006 to 7292 cases in 2019 (pâ=â0.001). The proportion of patients undergoing RC remained constant at about 75% in all age groups between 2006 and 2017 (pâ=â0.3). Relative to all performed RC, the proportion of patientsâ>â75 years increased from 25% in 2006 to 38% in 2019 (pâ=â0.03). The proportion of patients receiving a combination of RC and chemotherapy increased from 9% in 2006 to 13% in 2017 (pâ=â0.005). In 2006, 8 of 299 urology departments (2.7%) performed more than 50 RCs per year, which increased to 17 of 360 (4.7%) in 2019. In 2019, 107 departments (29%) performed 25â49 RCs and 236 (66%) departments performedâ<â25 RCs.
Conclusion:
In Germany, three out of four patients with MIBC receive RC and the proportion of patientsâ>â75 years is increasing. The combination of surgery and chemotherapy is increasingly used. With overall increasing case numbers, there is a slight tendency towards centralization.Peer Reviewe
Upper tract urothelial carcinoma in Germany: epidemiological data and surgical treatment trends in a total population analysis from 2006 to 2019
Purpose
To report contemporary epidemiological data and treatment trends for upper tract urothelial carcinoma (UTUC) in Germany over a 14-year period.
Methods
We analyzed data from the nationwide German hospital billing database and the German cancer registry from 2006 to 2018/2019. The significance of changes over time was evaluated via regression analysis. Survival outcomes were calculated using the KaplanâMeier method.
Results
There was a non-significant increase in the age-standardized incidence rate from 2.5/100,000 in 2006 to 2.9/100.000 in 2018. 13% of patients presented with lymph node metastasis and 7.6% of patients presented with distant metastasis at primary diagnosis. The 5-year overall survival was estimated at 45% and the 10-year overall survival at 32%. Endoscopic biopsies of the renal pelvis and ureter as well as ureteroscopies with excision/destruction of UTUC all increased significantly over the study period. The number of radical nephroureterectomies (RNU) for UTUC steadily increased from 1643 cases in 2006 to 2238 cases in 2019 (pâ<â0.005) with a shift from open surgery towards minimally invasive surgery. Complex reconstructive procedures like ileal ureter replacement or autotransplantation are rarely performed for urothelial carcinoma of the ureter.
Conclusion
Diagnostic and therapeutic procedures for UTUC have increased and minimally invasive nephroureterectomy is the predominant approach concerning radical surgery in 2019
Early CRP kinetics to predict longâterm efficacy of firstâline immuneâcheckpoint inhibition combination therapies in metastatic renal cell carcinoma: an updated multicentre realâworld experience applying different CRP kinetics definitions
Abstract Objectives Although biomarkers predicting therapy response in firstâline metastatic renal carcinoma (mRCC) therapy remain to be defined, Câreactive protein (CRP) kinetics have recently been associated with immunotherapy (IO) response. Here, we aimed to assess the predictive and prognostic power of two contemporary CRP kinetics definitions in a large, realâworld firstâline mRCC cohort. Methods Metastatic renal carcinoma patients treated with IOâbased firstâline therapy within 5âyears were retrospectively included in this multicentre study. According to Fukuda et al., patients were defined as âCRP flareâresponderâ, âCRP responderâ and ânonâCRP responderâ; according to Ishihara et al., patients were defined as ânormalâ, ânormalisedâ and ânonânormalisedâ based on their early CRP kinetics. Patient and tumor characteristics were compared, and treatment outcome was measured by overall (OS) and progressionâfree survival (PFS), including multivariable Cox regression analyses. Results Out of 316 mRCC patients, 227 (72%) were assigned to CRP groups according to Fukuda. Both CRP flareâ (HR [Hazard ratio]: 0.59) and CRP responders (HR: 0.52) had a longer PFS, but not OS, than nonâCRP responders. According to Ishihara, 276 (87%) patients were assigned to the respective groups, and both normal and normalised patients had a significantly longer PFS and OS, compared with nonânormalised group. Conclusion Different early CRP kinetics may predict therapy response in firstâline mRCC therapy in a large realâworld cohort. However, further research regarding the optimal timing and frequency of measurement is needed