MP58-12 DOES “LOW RISK” MUSCLE INVASIVE BLADDER CANCER ACTUALLY EXIST?

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive II1 Apr 2015MP58-12 DOES “LOW RISK” MUSCLE INVASIVE BLADDER CANCER ACTUALLY EXIST? Eugene Pietzak, Matthew Sterling, S. Bruce Malkowicz, and Thomas Guzzo Eugene PietzakEugene Pietzak More articles by this author , Matthew SterlingMatthew Sterling More articles by this author , S. Bruce MalkowiczS. Bruce Malkowicz More articles by this author , and Thomas GuzzoThomas Guzzo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2151AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite level one evidence demonstrating improved survival with neoadjuvant chemotherapy (NAC) for muscle invasive bladder cancer (MIBC), many eligible patients do not receive it prior to radical cystectomy (RC). Our objective was to determine if the absence of known preoperative risk factors can stratify patients at low risk for extravesical disease. METHODS We identified NAC-naive patients with clinical stage cT2N0M0 urothelial bladder cancer who underwent RC at our center. “High risk” cT2 patients, with either preoperative hydronephrosis or transurethral resection specimens with lymphovascular invasion (LVI) or mixed variant histology, were compared to cT2 patients without these adverse features, who were grouped as “low risk”. RESULTS Of 251 consecutive cT2 patients, 119 (47%) were high risk (LVI=31, hydronephrosis=69, mixed histology=54, ≥ 2 risk factors=70). High and low risk cohorts did not differ with regards to age, gender, race, BMI, smoking, comorbidities, prior intravesical therapy, or treatment delay. At time of RC, high risk patients more often had occult lymph node metastasis (39% v. 26.7% p=0.04) and tumor upstaging to pT3/4 disease (54% v. 40% p<0.001), with significantly fewer patients achieving pT0 status (2.5% v. 12.1% p=0.004). There was no difference in adjuvant chemotherapy rates (26% v. 25% p=0.8). Two and five year cancer specific survival (CSS) was 85% and 62.3% for low risk patients, but only 59.5% and 42% for high risk patients (log rank=0.006, Fine-Gray competing risk analysis sub-HR= 2.1 [95%CI=1.4 - 3.2]). Compared to those without risk factors, the odds ratio for bladder cancer specific mortality (BCSM) was 1.3 (95%CI=0.7-2.5) for one risk factor and 3.2 (95%CI=1.7-5.8) for ≥ 2 risk factors. On multi-variable analysis, only hydronephrosis (2.2 [95%CI=1.2-4.2]) and mixed histology (2.4 [95%CI=1.2-4.8]) were independently associated with BCSM. CONCLUSIONS RC alone provides good oncologic outcomes to many cT2 MIBC patients without preoperative adverse risk factors, particularly if hydronephosis & mixed variant histology are absent. However, even in “low risk” patients, tumor upstaging & lymph node involvement is not trivial, which must be included in informed decision making. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e725-e726 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eugene Pietzak More articles by this author Matthew Sterling More articles by this author S. Bruce Malkowicz More articles by this author Thomas Guzzo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...