MP65-08 THE ROLE OF TRANSURETHRAL RESECTION OF BLADDER TUMOR AFTER NEOADJUVANT CHEMOTHERAPY FOR MUSCLE INVASIVE BLADDER CANCER

Abstract

You have accessJournal of UrologyBladder Cancer: Staging1 Apr 2014MP65-08 THE ROLE OF TRANSURETHRAL RESECTION OF BLADDER TUMOR AFTER NEOADJUVANT CHEMOTHERAPY FOR MUSCLE INVASIVE BLADDER CANCER Denise Asafu-Adjei, Cheryl Lee, Ajjai Alva, Heather Crossley, Stephen Dailey, Khaled Hafez, Chang He, Brent Hollenbeck, Maha Hussain, Jeffrey Montgomery, James Montie, Todd Morgan, Ted Skolarus, David Smith, and Alon Weizer Denise Asafu-AdjeiDenise Asafu-Adjei More articles by this author , Cheryl LeeCheryl Lee More articles by this author , Ajjai AlvaAjjai Alva More articles by this author , Heather CrossleyHeather Crossley More articles by this author , Stephen DaileyStephen Dailey More articles by this author , Khaled HafezKhaled Hafez More articles by this author , Chang HeChang He More articles by this author , Brent HollenbeckBrent Hollenbeck More articles by this author , Maha HussainMaha Hussain More articles by this author , Jeffrey MontgomeryJeffrey Montgomery More articles by this author , James MontieJames Montie More articles by this author , Todd MorganTodd Morgan More articles by this author , Ted SkolarusTed Skolarus More articles by this author , David SmithDavid Smith More articles by this author , and Alon WeizerAlon Weizer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1905AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Cisplatin-based neoadjuvant chemotherapy (NAC) prior to radical cystectomy (RC) can improve survival for patients with muscle invasive bladder cancer (MIBC). A restaging transurethral resection of bladder tumor (rTURBT) after NAC might assess response to NAC, identify candidates for bladder preservation, improve staging, and perhaps impact survival by debulking residual tumor. This study assesses the role of restaging TURBT after NAC. METHODS This single-institution, retrospective study evaluated 520 bladder cancer patients who underwent NAC prior to intended cystectomy. Patients completing at least one infusion of NAC followed by rTURBT were eligible. Clinicopathologic data were abstracted from an institutional database. The log rank test and Cox proportional hazards model were used to assess survival outcomes; Bowker's Test of Symmetry was used to assess staging concordance. RESULTS Of 520 patients treated with NAC followed by TURBT 163 (31%) died of any cause. After NAC, the pT0 rate was 25%. In a multivariable model, rTURBT did not offer survival advantage for overall survival (p=0.20) or cancer specific survival (p=0.25). Concordance between clinical stage at rTURBT and pathologic stage at cystectomy was 24%; 47% of patients were clinically understaged. Restaging TURBT after NAC resulted in altered management in 47 (9.1%) patients who opted not to proceed with RC, underwent radiation therapy instead, or were unresectable. CONCLUSIONS Restaging TURBT after NAC does not offer a survival or staging advantage and changes disease management infrequently. The clinical utility of routine restaging TURBT after NAC is uncertain, and should be used in selected patients. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e694 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Denise Asafu-Adjei More articles by this author Cheryl Lee More articles by this author Ajjai Alva More articles by this author Heather Crossley More articles by this author Stephen Dailey More articles by this author Khaled Hafez More articles by this author Chang He More articles by this author Brent Hollenbeck More articles by this author Maha Hussain More articles by this author Jeffrey Montgomery More articles by this author James Montie More articles by this author Todd Morgan More articles by this author Ted Skolarus More articles by this author David Smith More articles by this author Alon Weizer More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...