MP26-11 THE TIMING OF RADICAL CYSTECTOMY FOR BCG FAILURE: COMPARISON OF OUTCOMES AND RISK FACTORS FOR PROGNOSIS

Abstract

You have accessJournal of UrologyBladder Cancer: Non-invasive I1 Apr 2015MP26-11 THE TIMING OF RADICAL CYSTECTOMY FOR BCG FAILURE: COMPARISON OF OUTCOMES AND RISK FACTORS FOR PROGNOSIS Christopher Haas, LaMont Barlow, G. Joel DeCastro, and James McKiernan Christopher HaasChristopher Haas More articles by this author , LaMont BarlowLaMont Barlow More articles by this author , G. Joel DeCastroG. Joel DeCastro More articles by this author , and James McKiernanJames McKiernan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1133AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical cystectomy (RC) is the first-line treatment after BCG failure. However, many patients initially refuse surgery and pursue salvage intravesical therapy (IVT). The aims of this study are to compare the pathologic and survival outcomes of patients who receive RC soon after BCG failure with those who receive additional salvage IVT prior to undergoing RC for non-muscle-invasive bladder cancer (NMIBC) and identify risk factors of prognosis for the entire cohort. METHODS A single-institutional database was reviewed for patients who underwent RC for persistent NMIBC after at least 1 BCG induction course from 1990 to 2012. Multivariable logistic regression analysis assessed risk factors for upstaging to muscle invasion on final pathology. Kaplan Meier curves and multivariable cox regression analyses identified predictors of OS and CSS. RESULTS 117 patients were identified who had RC for intermediate to high risk NMIBC treated with at least one induction course of BCG. The cohort was separated into 2 groups: Group 1 (n = 61) was comprised of patients treated only with BCG +/- IFN; group 2 (n = 56) received at least one additional salvage IVT after BCG. Mean courses of IVT for groups 1 and 2 were 1.4 (range 1-2) and 3.4 (range 2-6), respectively. Group 1 had 13 (21.3%) patients with muscle invasion on RC pathology while group 2 had 11 (19.6%). In the total cohort, significant risk factors for muscle invasion on multivariable analysis were the percent frequency of TURBTs with HG T1 in individual patients (OR 1.03, p < 0.001), the percent frequency of TURBTs with CIS (OR 1.02, p = 0.047) and age (OR 1.07, p = 0.033). On Kaplan Meier analysis, there was no difference in OS and CSS between groups 1 and 2. Controlling for percent frequency of TURBTs with HG T1 and CIS, age, presence of LVI, and prostatic urethra involvement on cox regression, group 2 did not have a significantly worse risk of dying after RC (OR 1.4, p = 0.32); only age (OR 1.06, p = 0.01) and LVI (OR 2.8, p = 0.02) achieved significance. While being in group 1 or 2 did not significantly predict ureteral or urethral involvement, higher frequency of CIS on TURBTs increased the risk of ureteral or urethral involvement (OR 1.35, p = 0.03), which was in turn a feature associated with worsened OS and CSS and on Kaplan Meier analysis (p = 0.003 and p = 0.01, respectively). CONCLUSIONS There was no statistically significant difference in pathologic or oncologic outcomes amongst earlier RC versus additional salvage IVT prior to RC. Appropriately selected candidates for salvage IVT appear to have equivalent outcomes should they remain with NMIBC prior to RC. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e297-e298 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Haas More articles by this author LaMont Barlow More articles by this author G. Joel DeCastro More articles by this author James McKiernan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...