MP34-05 THE PROGNOSTIC SIGNIFICANCE OF TNM STAGING IN BLADDER CANCER AFTER NEOADJUVANT CHEMOTHERAPY CAN BE ENHANCED WITH TUMOR REGRESSION GRADING

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You have accessJournal of UrologyBladder Cancer: Invasive II1 Apr 2017MP34-05 THE PROGNOSTIC SIGNIFICANCE OF TNM STAGING IN BLADDER CANCER AFTER NEOADJUVANT CHEMOTHERAPY CAN BE ENHANCED WITH TUMOR REGRESSION GRADING Roland Seiler, Htoo Zarni Oo, Tilman Todenhöfer, Ladan Fazli, Mads Daugaard, and Peter Black Roland SeilerRoland Seiler More articles by this author , Htoo Zarni OoHtoo Zarni Oo More articles by this author , Tilman TodenhöferTilman Todenhöfer More articles by this author , Ladan FazliLadan Fazli More articles by this author , Mads DaugaardMads Daugaard More articles by this author , and Peter BlackPeter Black More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1022AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Classification of response to neoadjuvant chemotherapy (NAC) in muscle-invasive bladder cancer (MIBC) is based primarily on TNM stage at cystectomy. We recently described post-NAC tumor regression grades (TRG) as an alternative method of risk stratification. Here we aim to validate our findings in an independent cohort and to integrate TRG with TNM staging. METHODS Fifty-five patients with MIBC received at least 3 cycles of cisplatin-based NAC and underwent cystectomy. As previously described (Fleischmann et al. Am J Surg Pathol 2014) TRG was assessed in cystectomy specimens by two independent investigators blinded to patient outcomes. TRG 1 represents absence of residual cancer, TRG 2 is characterized by predominant fibrosis containing scattered residual cancer cells, and TRG 3 shows residual cancer with minor component of fibrosis or absence of regressive changes. Major response to NAC was defined as absence of muscle invasive disease and lymph node involvement (<pT2 and pN0). The remaining patients were grouped in partial-responders (=pT2 or pN+ and TRG2) and non-responders (=pT2 or pN+ and TRG3), respectively. TNM stages with and without integration of TRG were correlated with overall survival (OS). RESULTS The 22/55 (40%) patients with major response to NAC had a significantly longer OS compared to the remaining patients (90% vs. 50% 5yr OS, p=0.005). TRG was successfully determined in all cases and concordance between both observers was high (91%). Of the 33/55 (60%) patients without major response, 13/55 (24%) and 20/55 (36%) were partial- and non-responders after combining TRG with the TNM stages. Kaplan-Meier estimates yielded an additional stratification of the cohort in 3 separated prognostic categories. Five-year OS of major-, partial- and non-responders was 90%, 65% and 40%, respectively. Multivariate survival analysis showed that the prognostic stratification of the cohort could be improved by integrating the TRG with the TNM stages (p<0.001). CONCLUSIONS Measurement of TRG after NAC is simple and reproducible. We successfully validated our prior discovery in an independent cohort. Moreover, integrating TRG with the current TNM classification significantly improved prognostic stratification. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e428 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Roland Seiler More articles by this author Htoo Zarni Oo More articles by this author Tilman Todenhöfer More articles by this author Ladan Fazli More articles by this author Mads Daugaard More articles by this author Peter Black More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...