MP16-05 UTILIZATION OF INITIAL CYSTECTOMY VERSUS INTRAVESICAL BACILLUS CALMETTE-GUÉRIN FOR NON-MUSCLE INVASIVE MICROPAPILLARY UROTHELIAL CARCINOMA OF THE BLADDER

Abstract

You have accessJournal of UrologyBladder Cancer: Non-invasive II (MP16)1 Sep 2021MP16-05 UTILIZATION OF INITIAL CYSTECTOMY VERSUS INTRAVESICAL BACILLUS CALMETTE-GUÉRIN FOR NON-MUSCLE INVASIVE MICROPAPILLARY UROTHELIAL CARCINOMA OF THE BLADDER Karishma Gupta, Danly Omil-Lima, Lin Chen, Wade Muncey, Irma Lengu, and Kyle Scarberry Karishma GuptaKarishma Gupta More articles by this author , Danly Omil-LimaDanly Omil-Lima More articles by this author , Lin ChenLin Chen More articles by this author , Wade MunceyWade Muncey More articles by this author , Irma LenguIrma Lengu More articles by this author , and Kyle ScarberryKyle Scarberry More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002001.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Micropapillary urothelial carcinoma is a rare and aggressive histologic variant of bladder cancer. Treatment guidelines recommend forgoing Bacillus Calmette-Guérin (BCG) therapy in favor of early radical cystectomy for non-muscle invasive micropapillary bladder cancer (NMI-MPBC) due to high rates of disease progression. We hypothesize that management of NMI-MPBC will vary across centers. METHODS: Patients with MPBC were identified from the National Cancer Database (2004-2017). Treatment trends and rates of pathological upstaging were identified. Bivariate and multivariate analyses were performed to assess differences in outcomes by treatment approach. RESULTS: 1,685 patients were diagnosed with MPBC during the study period with 531 identified to have localized Ta, T1, or Tis disease on presentation. BCG therapy was administered as initial therapy in 24.1% of NMI-MPBC patients and in 16.3% of non-micropapillary NMI-UC patients (p<0.001). Cystectomy was performed as primary therapy for NMI disease in 29.9% of MPBC and in 2.7% of non-micropapillary patients (p<0.001). Of the patients who underwent primary cystectomy, upstaging from NMI disease to T2-T4 disease was seen in 46.5% of the MPBC patients compared to 37.3% in patients with non-micropapillary disease (p=0.025). Upstaging to pathologic N1-3 disease was observed in 33.1% of MPBC patients compared to 11.9% non-micropapillary patients (p<0.001). Cystectomy as primary therapy for NMI-MPBC was more likely to be performed at academic (45.5%) compared to community cancer centers (15.6%) (p<0.001). On Cox regression analysis, adjusting for patient age, sex, race, comorbidities, and disease stage, care at academic cancer centers was associated with increased odds of having cystectomy as primary therapy compared to community cancer centers (OR = 4.29, 95% CI 2.73-6.76). Primary BCG therapy was not utilized any more frequently between academic (20.7%) and community cancer centers (27.1%) (p=0.093). CONCLUSIONS: The micropapillary variant of urothelial carcinoma is associated with increased odds of disease upstaging and node-positive disease. BCG is overutilized as primary treatment in this population. NMI-MPBC patients treated at academic centers were more likely to receive radical surgery as primary treatment compared to patients at community cancer centers. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e297-e297 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Karishma Gupta More articles by this author Danly Omil-Lima More articles by this author Lin Chen More articles by this author Wade Muncey More articles by this author Irma Lengu More articles by this author Kyle Scarberry More articles by this author Expand All Advertisement Loading ...