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Introduction <p>Muscle-invasive bladder cancer (MIBC) is an aggressive form of bladder cancer characterized by high rates of metastasis and recurrence. Given recent advances in the treatment landscape, real-world evidence on current treatment patterns and outcomes remains limited, particularly outside of the USA. This study aimed to describe characteristics, treatment patterns, and outcomes of patients with MIBC undergoing radical cystectomy (RC) in a contemporary real-world setting in Germany.</p> Methods <p>Adult patients with bladder cancer (BC) who underwent RC between October 2021 and June 2023 were identified from two German claims databases (AOK PLUS, GWQ). Patients with partial cystectomy, secondary malignant neoplasms, immunotherapies for metastatic disease prior to RC, radiotherapy, or in situ disease ≤ 6&#xa0;months pre-RC were excluded. Patient characteristics and treatment patterns (neoadjuvant [NAT, ≤ 6&#xa0;months pre-RC] and adjuvant periods [AT, ≤ 6&#xa0;months post-RC]) were investigated in a descriptive analysis. Time to recurrence (from RC until end of follow-up [study period end: Dec 31, 2023]) was assessed as an exploratory outcome.</p> Results <p>The study sample included 319 patients from AOK PLUS (<i>n</i> = 243 male patients, <i>n</i> = 76 female patients; mean age 71.4 ± 9.7&#xa0;years) and 273 patients from GWQ (<i>n</i> = 227 male patients, <i>n</i> = 46 female patients; mean age 68.6 ± 10.1&#xa0;years). Surgery without NAT/AT was the most common treatment (75.9% AOK, 74.0% GWQ). NAT and AT therapy utilization was low (NAT: 12.5% AOK, 17.2% GWQ; AT: 12.5% AOK, 12.1% GWQ; NAT and AT: 0.9% AOK, 3.3% GWQ). The most common adjuvant therapies received were chemotherapy (8.5% AOK, 7.0% GWQ) followed by immunotherapy/nivolumab (3.8% AOK, 4.8% GWQ), while &lt; 2.5% received radiotherapy. The 12- and 24-month recurrence-free survival rates were 76.5% and 67.2% (AOK) and 73.7% and 69.6% (GWQ), respectively.</p> Conclusion <p>The most prevalent treatment approach for MIBC was RC alone (in the absence of NAT or AT). The uptake of new therapeutic options, such as adjuvant nivolumab, in the real world was low, highlighting underutilization of available therapies.</p>

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Characteristics, Treatment Patterns, and Outcomes of Patients with Muscle-Invasive Bladder Cancer Undergoing Radical Cystectomy: A Retrospective Analysis of Health Insurance Claims Data in Germany

  • 期刊论文

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  • 发表日期：

    2026年1月20日

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  • Jennifer Stuart,
  • Evi Zhuleku,
  • Antje Mevius,
  • Patrick Squires,
  • Chethan Ramamurthy,
  • Barthold Deiters,
  • Mehmet Burcu

摘要

Introduction

Muscle-invasive bladder cancer (MIBC) is an aggressive form of bladder cancer characterized by high rates of metastasis and recurrence. Given recent advances in the treatment landscape, real-world evidence on current treatment patterns and outcomes remains limited, particularly outside of the USA. This study aimed to describe characteristics, treatment patterns, and outcomes of patients with MIBC undergoing radical cystectomy (RC) in a contemporary real-world setting in Germany.

Methods

Adult patients with bladder cancer (BC) who underwent RC between October 2021 and June 2023 were identified from two German claims databases (AOK PLUS, GWQ). Patients with partial cystectomy, secondary malignant neoplasms, immunotherapies for metastatic disease prior to RC, radiotherapy, or in situ disease ≤ 6 months pre-RC were excluded. Patient characteristics and treatment patterns (neoadjuvant [NAT, ≤ 6 months pre-RC] and adjuvant periods [AT, ≤ 6 months post-RC]) were investigated in a descriptive analysis. Time to recurrence (from RC until end of follow-up [study period end: Dec 31, 2023]) was assessed as an exploratory outcome.

Results

The study sample included 319 patients from AOK PLUS (n = 243 male patients, n = 76 female patients; mean age 71.4 ± 9.7 years) and 273 patients from GWQ (n = 227 male patients, n = 46 female patients; mean age 68.6 ± 10.1 years). Surgery without NAT/AT was the most common treatment (75.9% AOK, 74.0% GWQ). NAT and AT therapy utilization was low (NAT: 12.5% AOK, 17.2% GWQ; AT: 12.5% AOK, 12.1% GWQ; NAT and AT: 0.9% AOK, 3.3% GWQ). The most common adjuvant therapies received were chemotherapy (8.5% AOK, 7.0% GWQ) followed by immunotherapy/nivolumab (3.8% AOK, 4.8% GWQ), while < 2.5% received radiotherapy. The 12- and 24-month recurrence-free survival rates were 76.5% and 67.2% (AOK) and 73.7% and 69.6% (GWQ), respectively.

Conclusion

The most prevalent treatment approach for MIBC was RC alone (in the absence of NAT or AT). The uptake of new therapeutic options, such as adjuvant nivolumab, in the real world was low, highlighting underutilization of available therapies.