1419 PATHOLOGY-BASED RISK STRATIFICATION OF MUSCLE-INVASIVE BLADDER CANCER PATIENTS UNDERGOING CYSTECTOMY FOR PERSISTENT DISEASE AFTER INDUCTION CHEMORADIATION IN BLADDER-SPARING PROTOCOLS

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive1 Apr 20111419 PATHOLOGY-BASED RISK STRATIFICATION OF MUSCLE-INVASIVE BLADDER CANCER PATIENTS UNDERGOING CYSTECTOMY FOR PERSISTENT DISEASE AFTER INDUCTION CHEMORADIATION IN BLADDER-SPARING PROTOCOLS Fumitaka Koga, Minato Yokoyama, Junichiro Ishioka, Noboru Numao, Kazutaka Saito, Hitoshi Masuda, Yasuhisa Fujii, Satoru Kawakami, and Kazunori Kihara Fumitaka KogaFumitaka Koga Tokyo, Japan More articles by this author , Minato YokoyamaMinato Yokoyama Tokyo, Japan More articles by this author , Junichiro IshiokaJunichiro Ishioka Tokyo, Japan More articles by this author , Noboru NumaoNoboru Numao Tokyo, Japan More articles by this author , Kazutaka SaitoKazutaka Saito Tokyo, Japan More articles by this author , Hitoshi MasudaHitoshi Masuda Tokyo, Japan More articles by this author , Yasuhisa FujiiYasuhisa Fujii Tokyo, Japan More articles by this author , Satoru KawakamiSatoru Kawakami Tokyo, Japan More articles by this author , and Kazunori KiharaKazunori Kihara Tokyo, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1310AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bladder-sparing protocols with TUR + chemoradiotherapy (CRT) against muscle-invasive bladder cancer (MIBC) contribute to improvement of patients′ QOL. In most protocols, patients who achieve complete response (CR) to induction CRT are subjects of bladder preservation; they enjoy good QOL and favorable prognosis while non-CR patients have poorer prognosis despite radical cystectomy (RC). Risk stratification of non-CR patients would allow personalized adjuvant therapy and eventually improve survival outcomes of bladder-sparing protocols. METHODS From 1997 to 2009, consecutive 170 cT2-4aN0M0 MIBC patients underwent TUR followed by induction CRT (40 Gy with cisplatin). 4 to 6 wk after completion of CRT, clinical response was evaluated. When patients meet partial cystectomy (PC) criteria, they undergo PC+pelvic lymph node dissection for bladder preservation. Otherwise, RC is recommended. The PC criteria include 1) intact bladder neck and trigone, 2) intravesically localized tumors, and 3) CR or minimal amounts of residual non-MIBC after induction CRT. Pathology-based risk factors for cancer death were determined in 122 patients who underwent PC (n=44) or RC (n=78). RESULTS Of 170 patients, 82 (48%) achieved clinical CR. 5-yr cancer-specific survival (CSS) rate was 96% for the CR patients vs 51% for non-CR (p<.0001, median followup 47 m). Pathological findings of 122 cystectomy specimens were: pT0/Ta,is,1/T2/T3/T4a=59/26/10/24/3; median (range) no. lymph nodes removed, 9 (0–27); pN0/N+/Nx=102/8/12; lymphovascular invasion, no/yes=91/31. Among these variables, pT3-4a (hazard ratio [HR] 8.3 vs pT0-2, p<.0001) and pN+ (HR 3.0 vs pN0, p=.037) were identified as significant and independent risk factors for cancer death. Based on these risk factors, CSS of non-CR patients was clearly stratified into high-risk (pT3-4a and/or pN+, 5-yr CSS rate 20%) and low-risk (pT0-2pN0, 5-yr CSS rate 85%). CONCLUSIONS In bladder-sparing protocols, non-CR patients after induction CRT, generally having poor prognosis despite cystectomy, are clearly stratified into favorable vs high risk group based on pathology of cystectomy specimens. Patients at high-risk (pT3-4a and/or pN+) are potential subjects for intensive adjuvant therapy including clinical trials. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e568-e569 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fumitaka Koga Tokyo, Japan More articles by this author Minato Yokoyama Tokyo, Japan More articles by this author Junichiro Ishioka Tokyo, Japan More articles by this author Noboru Numao Tokyo, Japan More articles by this author Kazutaka Saito Tokyo, Japan More articles by this author Hitoshi Masuda Tokyo, Japan More articles by this author Yasuhisa Fujii Tokyo, Japan More articles by this author Satoru Kawakami Tokyo, Japan More articles by this author Kazunori Kihara Tokyo, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...