MP72-12 OUTCOMES OF RADICAL CYSTECTOMY IN POTENTIAL CANDIDATES FOR BLADDER PRESERVATION THERAPY

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive V1 Apr 2015MP72-12 OUTCOMES OF RADICAL CYSTECTOMY IN POTENTIAL CANDIDATES FOR BLADDER PRESERVATION THERAPY 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.2015.02.2646AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bladder Preservation Therapy (BPT) in urothelial-type bladder cancer (UBC) is often compared to Radical Cystectomy (RC). However, BPT patients are subject to stringent selection criteria which limit comparisons. Our objective was to analyze the outcomes of RC in patients who otherwise met criteria for BPT. METHODS We identified consecutive patients with clinical stage cT2N0M0 UBC who underwent RC with curative intent at our academic center. Patients without carcinoma in-situ (CIS), hydronephrosis, multifocality, or mixed histology were classified as BPT-eligible. Patients with ≥1 contraindications were considered BPT-ineligible. Clinicopathologic characteristics and survival outcomes for BPT-eligible were compared to ineligible patients. RESULTS 275 patients had cT2N0M0 UBC, of which 157 (57.1%) were BPT-ineligible (CIS=54; hydro=77; multifocality=29; mixed histology=55; ≥2 contraindications=51). BPT-eligible and ineligible patients did not statistically differ with regards to age, gender, race, or neoadjuvant chemotherapy. Of the BPT-eligible patients, 24.1% had occult positive lymph nodes and 36.4% had pT3/pT4 tumors at RC. On multivariable analysis, mixed histology (OR=3.18[95%CI:1.18-8.56]) and progression from non-invasive disease to cT2 (OR=4.81[95%CI:1.67-13.85]) were independently associated with upstaging. Two-year overall survival was higher in BPT-eligible patients (76.7% v. 57.1% p=0.003; HR=0.48[95%CI:0.3-0.78]). BPT-eligible patients also had better cancer-specific mortality on competing risk analysis (Sub-HR=0.46[95%CI=0.29-0.72] p=0.001). CONCLUSIONS Substantial clinical-pathologic stage discrepancies occurred even in patients seemingly ideal for BPT, which may provide insight into BPT failures. Furthermore, substantial survival discrepancies occurred between BPT-eligible and BPT-ineligible patients despite being the same clinical stage. In the absence of randomized trials, comparisons between RC and BPT must factor in selection bias. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e925 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 ...