Introduction:

An immediate postoperative dose of chemotherapy reduces intravesical recurrences and is a guideline-recommended practice, but is widely underutilized. We sought to assess whether utilization of an immediate postoperative dose of intravesical chemotherapy following bladder tumor resection has increased with increased use of gemcitabine for this purpose. 

Methods:

We performed a retrospective cohort study on all patients who had transurethral resection of bladder tumor at our facility from 2015-2019. We determined whether each patient was an ideal candidate for postoperative intravesical chemotherapy based on pathologic stage. We then assessed whether each candidate received intravesical chemotherapy, and, if so, what medication was used. We used chi-squared analysis to compare differences in gemcitabine use between 2018-19. We used logistic regression to assess the relationship between any intravesical chemotherapy use and year of procedure.

Results:

We identified 1,011 patients with stage pTa/T1 non-muscle-invasive bladder cancer without carcinoma in situ. During 2015-17, all patients who received intravesical chemotherapy were given mitomycin C. In 2018, gemcitabine was used in 76% of cases and in 94% in 2019. We observed significantly higher usage of gemcitabine in 2019 compared to 2018 (p=0.049). Overall utilization for eligible cases was 16%. The rate of any intravesical chemotherapy use was not significantly associated with year of procedure (OR 1.09, with 95% CI [0.98, 1.23], p=0.126).

Conclusion:

Since its introduction in 2018, gemcitabine has almost entirely replaced mitomycin C for intravesical chemotherapy at our institution. Further research is needed to determine if overall utilization of postoperative intravesical chemotherapy for treatment of non-muscle-invasive bladder cancer has increased.

Funding: Summer Research Grant from NIDDK: 5T35DK093430