MP63-08 CLINICAL AND GENOMIC RISK FEATURES OF HIGH GRADE T1 NON-MUSCLE INVASIVE BLADDER CANCER

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP63-08 CLINICAL AND GENOMIC RISK FEATURES OF HIGH GRADE T1 NON-MUSCLE INVASIVE BLADDER CANCER Carissa Chu, Jessica Chen, Manuel DE Jesus Escano, Karissa Whiting, Irina Ostrovnaya, Song Jiang, Wesley Yip, Sari Khaleel, Andrew Lenis, Timothy Clinton, Goh Alvin, CHA Eugene, Timothy Donahue, Guido Dalbagni, Gopa Iyer, David Solit, Judy Sarungbam, Hikmat AL-Ahmadie, Bernard Bochner, and Eugene Pietzak Carissa ChuCarissa Chu More articles by this author , Jessica ChenJessica Chen More articles by this author , Manuel DE Jesus EscanoManuel DE Jesus Escano More articles by this author , Karissa WhitingKarissa Whiting More articles by this author , Irina OstrovnayaIrina Ostrovnaya More articles by this author , Song JiangSong Jiang More articles by this author , Wesley YipWesley Yip More articles by this author , Sari KhaleelSari Khaleel More articles by this author , Andrew LenisAndrew Lenis More articles by this author , Timothy ClintonTimothy Clinton More articles by this author , Goh AlvinGoh Alvin More articles by this author , CHA EugeneCHA Eugene More articles by this author , Timothy DonahueTimothy Donahue More articles by this author , Guido DalbagniGuido Dalbagni More articles by this author , Gopa IyerGopa Iyer More articles by this author , David SolitDavid Solit More articles by this author , Judy SarungbamJudy Sarungbam More articles by this author , Hikmat AL-AhmadieHikmat AL-Ahmadie More articles by this author , Bernard BochnerBernard Bochner More articles by this author , and Eugene PietzakEugene Pietzak More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003321.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: High grade non-muscle invasive bladder cancer invading the lamina propria (HG T1) exhibits variable clinical behavior. Existing risk stratification approaches by clinicopathologic alone are limited in determining who will benefit most from immediate radical cystectomy (RC) versus BCG. We report contemporary outcomes of patients managed with BCG or immediate RC and comparative mutational landscape across the spectrum of HG T1 disease. METHODS: This was a single-center retrospective cohort study of patients newly diagnosed with HG T1 non-muscle invasive bladder cancer between 2014 and 2020>18 months of follow up. All included patients underwent restaging TURBT with confirmed T1 by TURBT/EUA/imaging. Targeted exome sequencing with MSK-IMPACT was performed on 139 HG T1 tumors and 191 T2 tumors. RESULTS: 390 patients were included with median follow up time of 35 months (IQR 19-59 months). 308 were managed with intravesical BCG and 82 immediate RC. Patients selected for immediate RC were younger (median age 66 vs 69, p<0.001) and had higher rates of concurrent CIS (78 vs 53%, p<0.001), deep lamina propria invasion (37 vs 17%, p<0.001), lymphovascular invasion (7 vs 0.3%, p<0.001), and larger tumor size (4.3 cm vs 3.3 cm, p=0.007). Of the 82 patients who immediate radical cystectomy (BCG naïve), 32 (40%) were upstaged to pT2 and/or N+disease at RC. Persistent pT1 disease at re-resection and the presence of variant histology were associated with pathologic upstaging (p<0.01), while tumor size, concurrent CIS, bladder neck involvement, or prostatic urethra involvement were not. Compared to patients without additional risk factors, patients with CIS and at least one additional risk (e.g . “very high risk” T1 disease) harbored more TP53, ERBB2/Her2, and RB1 mutations and fewer FGFR3 mutations and a genomic profile more similar to T2 tumors than NMIBC (Figure 1). CONCLUSIONS: Very high risk T1 tumors are genomically similar to muscle-invasive tumors and are enriched in targetable alterations including ERBB2/Her2. Integration of genomic sequencing with clinical and pathologic features of HG T1 disease may improve risk stratification and treatment selection. Source of Funding: Ruth L. Kirschstein National Research Service Award T32CA082088 American Society of Clinical Oncology Young Investigator Award (YIA) Award © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e874 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Carissa Chu More articles by this author Jessica Chen More articles by this author Manuel DE Jesus Escano More articles by this author Karissa Whiting More articles by this author Irina Ostrovnaya More articles by this author Song Jiang More articles by this author Wesley Yip More articles by this author Sari Khaleel More articles by this author Andrew Lenis More articles by this author Timothy Clinton More articles by this author Goh Alvin More articles by this author CHA Eugene More articles by this author Timothy Donahue More articles by this author Guido Dalbagni More articles by this author Gopa Iyer More articles by this author David Solit More articles by this author Judy Sarungbam More articles by this author Hikmat AL-Ahmadie More articles by this author Bernard Bochner More articles by this author Eugene Pietzak More articles by this author Expand All Advertisement PDF downloadLoading ...