MP13-20 LONG TERM OUTCOMES IN PATIENTS WITH MUSCLE INVASIVE BLADDER CANCER WHO ARE MISCLASSIFIED AS ACHIEVING A COMPLETE CLINICAL RESPONSE TO NEOADJUVANT CHEMOTHERAPY: HOW COSTLY ARE MISTAKES?

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive I (MP13)1 Sep 2021MP13-20 LONG TERM OUTCOMES IN PATIENTS WITH MUSCLE INVASIVE BLADDER CANCER WHO ARE MISCLASSIFIED AS ACHIEVING A COMPLETE CLINICAL RESPONSE TO NEOADJUVANT CHEMOTHERAPY: HOW COSTLY ARE MISTAKES? Jane Kurtzman, Rainjade Chung, Helena Vila-Reyes, Guarionex Decastro, Christopher Anderson, Charles Drake, and James McKiernan Jane KurtzmanJane Kurtzman More articles by this author , Rainjade ChungRainjade Chung More articles by this author , Helena Vila-ReyesHelena Vila-Reyes More articles by this author , Guarionex DecastroGuarionex Decastro More articles by this author , Christopher AndersonChristopher Anderson More articles by this author , Charles DrakeCharles Drake More articles by this author , and James McKiernanJames McKiernan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001994.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Correctly classifying patients with muscle invasive bladder cancer (MIBC) as achieving a complete response to neoadjuvant chemotherapy (NAC) is challenging without radical cystectomy (RC) pathology. The accuracy of clinical staging following NAC is debated and the risk of occult residual MIBC is real. In this study, we present the survival outcomes of patients who were misclassified as having achieved a complete clinical response (CCR) to NAC. METHODS: We retrospectively reviewed our prospective database of patients with MIBC who achieved a CCR to NAC and elected active surveillance (AS). CCR criteria includes: negative cytology, benign TUR pathology and negative cross-sectional imaging. We defined misclassified CCR (mCCR) as a patient found to have intravesical MIBC within 6 months of meeting CCR criteria. Kaplan-Meier curves were used to assess overall (OS), cancer-specific (CSS) and metastasis-free (MFS) survival and log-rank tests to evaluate differences between cohorts. RESULTS: We included 54 patients, with a median age of 70 years (IQR 62-75) and median follow-up of 49 months (IQR 26-77) since MIBC diagnosis. 6/54 patients (11%) were mCCR. All 6 underwent RC at a mean of 129 days after CCR classification. Five-year OS, CSS and MFS for mCCR patients was 63%, compared to 80%, 89% and 93%, respectively, for the remaining patients (Figure 1). Log-rank tests revealed a significantly higher OS and MFS in CCR compared to mCCR patients (p=0.03 and p=0.05, respectively), but no difference in CSS (p=0.07). However, this lack of significance was likely due to lack of power. CONCLUSIONS: We observed an 11% rate of occult MIBC in patients who elect AS following a CCR to NAC. Delayed RC in this cohort resulted in a 63% 5-year OS, CSS and MFS. These survival outcomes for mCCR patients are comparable to those previously published for patients who undergo immediate RC following NAC and are found to have residual intravesical MIBC on specimen review. Our findings are useful when describing the risk of occult MIBC to patients contemplating AS. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e251-e251 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jane Kurtzman More articles by this author Rainjade Chung More articles by this author Helena Vila-Reyes More articles by this author Guarionex Decastro More articles by this author Christopher Anderson More articles by this author Charles Drake More articles by this author James McKiernan More articles by this author Expand All Advertisement Loading ...