MP55-15 SHOULD WE CONSIDER ALL AJCC STAGE IIIB BCA EQUAL? THE IMPACT OF LOCAL T STAGING IN N2 AND N3 PATIENTS AFTER RADICAL CYSTECTOMY

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive II (MP55)1 Apr 2020MP55-15 SHOULD WE CONSIDER ALL AJCC STAGE IIIB BCA EQUAL? THE IMPACT OF LOCAL T STAGING IN N2 AND N3 PATIENTS AFTER RADICAL CYSTECTOMY Emanuele Zaffuto*, Marco Bandini, Simone Scuderi, Marco Moschini, Giusy Burgio, Andrea Salonia, Giorgio Gandaglia, Nicola Fossati, Roberto Bertini, Vincenzo Scattoni, Federico Dehò, Alberto Briganti, Francesco Montorsi, Renzo Colombo, Andrea Necchi, and Andrea Gallina Emanuele Zaffuto*Emanuele Zaffuto* More articles by this author , Marco BandiniMarco Bandini More articles by this author , Simone ScuderiSimone Scuderi More articles by this author , Marco MoschiniMarco Moschini More articles by this author , Giusy BurgioGiusy Burgio More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Roberto BertiniRoberto Bertini More articles by this author , Vincenzo ScattoniVincenzo Scattoni More articles by this author , Federico DehòFederico Dehò More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Renzo ColomboRenzo Colombo More articles by this author , Andrea NecchiAndrea Necchi More articles by this author , and Andrea GallinaAndrea Gallina More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000924.015AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Current AJCC staging defines stage IIIB disease in bladder cancer (BCa) as patients with pN2 or pN3 disease, regardless of local staging (T stage). However, long term survival in this cohort of patients is not invariably unfavorable. We tested the prognostic impact of T stage in AJCC Stage IIIB BCa in patients treated with radical cystectomy (RC) METHODS: We identified a total of 499 patients with pathological N2 or N3 disease at RC, treated at a single tertiary care center. Descriptive statistics showed the differences in clinical features of patients included in the study. Kaplan-Meier plots described the recurrence and survival figures of the study population after stratification according to local T stage (pT0-T2 vs. pT3 vs. pT4a) and according to pN2 and pN3 disease. A novel risk stratification was defined according to different combination of T and N stages and was tested in Kaplan-Meier as well as after univariable and multivariable Cox regression analyses assessing disease recurrence and cancer-specific mortality after RC RESULTS: A total of 50 (10%), 236 (47.3%) and 213 (42.7%) patients were identified with pT0-pT2, pT3 and pT4a disease, respectively. The proportion of individuals with pN3 disease was 15.6% (n=78). At 3 years, recurrence-free survival rates were 57.4%, 27.6% and 13.2% in patients with pT0-pT2, pT3 and pT4a disease, respectively (p<0.001), while CSS rates were 72.8%, 52.4% and 31.5%, respectively (p<0.001). After stratification according to pN2 vs pN3 disease, 3-years recurrence-free survival rates were 58%, 29.5% and 13.2%, respectively, among patients with pN2 disease (p<0.01), and 66.7%, 20.7% and 10.4%, respectively, for pN3 individuals (p=0.03). We stratified patients in 3 risk groups according to: Low risk pT0-pT2 disease in pN2 individuals; Intermediate risk pT3 disease among pN2 individuals; High risk pT4a or pN3. Our stratification showed a significant difference in recurrence and CSS rates across the 3 groups. Specifically, in multivariable Cox regression analyses, intermediate and high-risk conferred a 2.37- and 4.06-fold increased risk of disease recurrence, compared to low-risk disease, and 11- and 17-fold increased risk of cancer-specific mortality, compared to low-risk patients (all p<0.05) CONCLUSIONS: Our results should suggest that a substaging of AJCC stage IIIB treated with RC, accounting for local tumor staging offers a higher discrimination on both recurrence and survival. In light of our results, a re-stratification of stage IIIB BCa should be advocated Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e843-e844 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Emanuele Zaffuto* More articles by this author Marco Bandini More articles by this author Simone Scuderi More articles by this author Marco Moschini More articles by this author Giusy Burgio More articles by this author Andrea Salonia More articles by this author Giorgio Gandaglia More articles by this author Nicola Fossati More articles by this author Roberto Bertini More articles by this author Vincenzo Scattoni More articles by this author Federico Dehò More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Renzo Colombo More articles by this author Andrea Necchi More articles by this author Andrea Gallina More articles by this author Expand All Advertisement PDF downloadLoading ...