MP63-06 BACILLUS CALMETTE-GUERIN VS IMMEDIATE RADICAL CYSTECTOMY IN EAU DEFINED VERY HIGH-RISK NON-MUSCLE INVASIVE BLADDER CANCER PATIENTS

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP63-06 BACILLUS CALMETTE-GUERIN VS IMMEDIATE RADICAL CYSTECTOMY IN EAU DEFINED VERY HIGH-RISK NON-MUSCLE INVASIVE BLADDER CANCER PATIENTS Roberto Contieri, Patrick Hensley, Wei Shen Tan, Valentina Grajales, Kelly Bree, Charles C Guo, Graciela M Nogueras-Gonzalez, Neema Navai, Colin P Dinney, and Ashish M Kamat Roberto ContieriRoberto Contieri More articles by this author , Patrick HensleyPatrick Hensley More articles by this author , Wei Shen TanWei Shen Tan More articles by this author , Valentina GrajalesValentina Grajales More articles by this author , Kelly BreeKelly Bree More articles by this author , Charles C GuoCharles C Guo More articles by this author , Graciela M Nogueras-GonzalezGraciela M Nogueras-Gonzalez More articles by this author , Neema NavaiNeema Navai More articles by this author , Colin P DinneyColin P Dinney More articles by this author , and Ashish M KamatAshish M Kamat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003321.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: European Association of Urology (EAU) guidelines recommend offering immediate radical cystectomy (iRC) to all very high-risk (VHR) non-muscle invasive bladder cancer (NMIBC) patients and reserving BCG for only those who refuse or are unfit for RC. Herein, we assessed survival outcomes of VHR NMIBC patients treated with BCG versus iRC. METHODS: We performed an IRB approved retrospective study analyzing VHR NMIBC patients according to the EAU definition diagnosed between 2000 and 2020. Survival outcomes between the following patient cohorts were compared: 1) Immediate RC versus BCG and 2) Immediate RC versus delayed RC. Primary endpoint was overall-(OS) and cancer-specific survival (CSS). The cumulative incidence (CI) method was used to estimate the risk of cancer-specific mortality (CSM) after accounting for other causes of death as a competing risk event. Multivariate competing-risks regression analyses were used to predict CSM. RESULTS: A total of 235 VHR patients were identified (157 BCG versus 78 iRC). The median follow-up was 45.8 months. Patients treated with iRC were younger (68 yrs vs. 72 yrs; p<0.01), had a higher prevalence of lymphovascular invasion (LVI) (29.5% vs 4.5%; p<0.01) and variant histology (53.8% vs 16.6%; p<0.01) at diagnosis. The 5-yr OS and CSM were 80.2% and 5.3% in patients undergoing BCG and 88.1% and 4.9% in patients undergoing iRC. Survival outcomes did not significantly differ between the two groups (p=0.604 and p=0.955, respectively; Figure). Treatment strategy was not associated with CSM in the multivariate competing-risk regression model (Sub-standardized Hazard ratio (SHR): 1.54; 95% CI 0.24 – 9.68; p=0.65). Among the patients treated with BCG, 5-yr PF rate was 82.6%. A total of 39 (24.8%) patients underwent delayed RC following recurrence after BCG. Patients who underwent delayed RC did not exhibit worse oncological outcomes relative to those treated with iRC (SHR: 0.66, 95% CI: 0.17-2.61, p=0.56). CONCLUSIONS: Survival outcomes following initial treatment with intravesical BCG (with delayed RC if needed) for selected VHR NMIBC can be effective and oncologically safe. Source of Funding: This research was supported by the Wayne B. Duddlesten Professorship in Cancer Research, the Raymond and Maria Floyd Bladder Cancer Research Foundation Grant, NIH/NCI UTMD Anderson SPORE in Genitourinary Cancer (p50CA091846), the Cancer Center Support Grant (NCI Grant P30 CA016672) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e873 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Roberto Contieri More articles by this author Patrick Hensley More articles by this author Wei Shen Tan More articles by this author Valentina Grajales More articles by this author Kelly Bree More articles by this author Charles C Guo More articles by this author Graciela M Nogueras-Gonzalez More articles by this author Neema Navai More articles by this author Colin P Dinney More articles by this author Ashish M Kamat More articles by this author Expand All Advertisement PDF downloadLoading ...