MP55-02 DO CIRCULATING TUMOR CELLS HELP IN DECISION-MAKING REGARDING ADJUVANT CHEMOTHERAPY IN PATIENTS WITH UROTHELIAL CARCINOMA OF THE BLADDER TREATED WITH RADICAL CYSTECTOMY?

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive II1 Apr 2014MP55-02 DO CIRCULATING TUMOR CELLS HELP IN DECISION-MAKING REGARDING ADJUVANT CHEMOTHERAPY IN PATIENTS WITH UROTHELIAL CARCINOMA OF THE BLADDER TREATED WITH RADICAL CYSTECTOMY? Armin Soave, Sabine Riethdorf, Lars Weisbach, Sarah Minner, Oliver Engel, Jens Hansen, Felix K. Chun, Roland Dahlem, Klaus Pantel, Margit Fisch, and Michael Rink Armin SoaveArmin Soave More articles by this author , Sabine RiethdorfSabine Riethdorf More articles by this author , Lars WeisbachLars Weisbach More articles by this author , Sarah MinnerSarah Minner More articles by this author , Oliver EngelOliver Engel More articles by this author , Jens HansenJens Hansen More articles by this author , Felix K. ChunFelix K. Chun More articles by this author , Roland DahlemRoland Dahlem More articles by this author , Klaus PantelKlaus Pantel More articles by this author , Margit FischMargit Fisch More articles by this author , and Michael RinkMichael Rink More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1550AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Circulating tumor cells (CTC) in urothelial carcinoma of the bladder (UCB) patients treated with radical cystectomy (RC) are predictors for unfavorable outcomes. Administration of adjuvant chemotherapy is associated with improved survival in some UCB patients. To evaluate if determination of CTC may help in patient counseling regarding administration of adjuvant chemotherapy. Methods We prospectively collected data of 181 UCB patients treated with RC without neoadjuvant chemotherapy at an academic center between 2007 and 2012. Preoperatively collected blood samples (7.5ml) were analyzed for CTC using the CellSearch® system (Veridex, USA). We correlated clinico-pathologic parameters and outcomes with administration of adjuvant chemotherapy and according to the CTC status. Cox regression models evaluated the association with disease recurrence and cancer-specific survival, respectively. Results In total, 40 patients (22.1%) had presence of CTC (mean number: 11±34; median: 1) prior to RC. Adjuvant chemotherapy (86.9% Cisplatin-based) was administered to 46 patients (25.4%) with a median number of 4 cycles (range: 1-6). Administration of adjuvant chemotherapy was significantly associated with younger age, advanced pT-stage, higher grade, lymph node metastasis, presence of LVI and positive soft tissue margin status (p-values ≤0.039). Patients with presence of CTC received more often adjuvant chemotherapy (CTC pos vs. neg: 35% vs. 18%; p=0.023). At a mean follow-up of 30 months, CTC presence was associated with disease recurrence and cancer-specific mortality (both p<0.001), respectively, in patients without adjuvant chemotherapy. In contrast, in patients who received adjuvant chemotherapy CTC status was not associated with outcomes. In multivariable analysis that adjusted for age, pT-stage, tumor grade, lymph node metastasis, LVI and margin status, presence of CTC was an independent predictor for disease recurrence (HR 3.94; 95%CI 1.77-8.77; p=0.001) and cancer specific mortality (HR 3.83; 95%CI 1.56-9.38; p=0.003), respectively, in patients without adjuvant chemotherapy administration. Conclusions Presence of CTC is a strong predictor for outcomes in UCB patients treated with RC without adjuvant chemotherapy. Thus, CTC status may be used for patient counseling and decision- making regarding further therapies in patients who otherwise would not be counseled regarding adjuvant therapies. In addition, adjuvant chemotherapy may abrogate the impact of CTC on survival. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e555 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Armin Soave More articles by this author Sabine Riethdorf More articles by this author Lars Weisbach More articles by this author Sarah Minner More articles by this author Oliver Engel More articles by this author Jens Hansen More articles by this author Felix K. Chun More articles by this author Roland Dahlem More articles by this author Klaus Pantel More articles by this author Margit Fisch More articles by this author Michael Rink More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...