1443 ROLE OF COMPLETE TRANSURETHRAL RESECTION IN BLADDER CANCER PRIOR TO CYSTECTOMY: IS THERE BENEFIT WHEN GIVING NEOADJUVANT CHEMOTHERAPY?

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive (I)1 Apr 20131443 ROLE OF COMPLETE TRANSURETHRAL RESECTION IN BLADDER CANCER PRIOR TO CYSTECTOMY: IS THERE BENEFIT WHEN GIVING NEOADJUVANT CHEMOTHERAPY? Andrew James, Franklin Lee, William Harris, Heather Cheng, Song Zhao, John Gore, Dan Lin, Michael Porter, Evan Yu, and Jonathan Wright Andrew JamesAndrew James Seattle, WA More articles by this author , Franklin LeeFranklin Lee Seattle, WA More articles by this author , William HarrisWilliam Harris Seattle, WA More articles by this author , Heather ChengHeather Cheng Seattle, WA More articles by this author , Song ZhaoSong Zhao Seattle, WA More articles by this author , John GoreJohn Gore Seattle, WA More articles by this author , Dan LinDan Lin Seattle, WA More articles by this author , Michael PorterMichael Porter Seattle, WA More articles by this author , Evan YuEvan Yu Seattle, WA More articles by this author , and Jonathan WrightJonathan Wright Seattle, WA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2797AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previous studies indicate that neoadjuvant chemotherapy (NC) before cystectomy improves survival in patients with muscle invasive bladder cancer. NC is also associated with a higher rate of pathologic T0 status at cystectomy. However, the effect of complete endoscopic debulking of bladder tumor before NC is not clarified. We sought to examine the potential benefit of complete debulking before cystectomy on final pathologic staging with or without NC in patients who underwent radical cystectomy for bladder cancer. METHODS We conducted a retrospective review of patients with clinical T2-T4N0-1 urothelial carcinoma of the bladder who underwent cystectomy at our institution between July 2005 and November 2011. Operative reports from the transurethral resection (TUR) were examined to determine subjective completeness of endoscopic debulking. Multivariate logistic regression was performed to determine the association of complete TUR on pT0 status at cystectomy. A model including all patients (adjusting for age, gender, race, NC, complete TUR) and a multivariate model limited to those receiving NC were performed. RESULTS A total of 168 patients underwent cystectomy, 82 of which received NC. Complete TUR was performed in 38% of patients who did not receive NC and in 48% of patients who received NC (p= 0.17). There was no difference in age, gender, and race between groups based on complete TUR status. In the model including all patients, those receiving NC had higher likelihood of pT0 at cystectomy than those undergoing cystectomy alone (28% vs. 9%, respectively, OR 3.55, 95% CI 1.45-8.69, p<0.01). In addition, having a complete TUR was associated with a 2-fold increase of pT0 status (OR 2.18, 95% CI 0.95-4.99, p=0.07). In the multivariate model limited to those who received NC, there was a significant association with complete debulking and pT0 rates at cystectomy (OR: 3.24, 95% CI 1.09-9.59, p= 0.03). CONCLUSIONS Complete debulking prior to NC is strongly associated with complete pathologic tumor response at radical cystectomy. Patients with muscle invasive bladder cancer who are candidates for radical cystectomy should undergo complete debulking at transurethral resection when feasible even if NC is planned. Prior studies demonstrating better cancer outcomes among pT0 patients at cystectomy suggest that complete endoscopic debulking could lead to improved cancer-specific survival. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e591 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew James Seattle, WA More articles by this author Franklin Lee Seattle, WA More articles by this author William Harris Seattle, WA More articles by this author Heather Cheng Seattle, WA More articles by this author Song Zhao Seattle, WA More articles by this author John Gore Seattle, WA More articles by this author Dan Lin Seattle, WA More articles by this author Michael Porter Seattle, WA More articles by this author Evan Yu Seattle, WA More articles by this author Jonathan Wright Seattle, WA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...