MP73-13 MULTI-INSTITUTIONAL OUTCOMES OF PATIENTS WITH HIGH-RISK NON-MUSCLE INVASIVE BLADDER CANCER (NMIBC) WHO UNDERGO RADICAL CYSTECTOMY AFTER BCG AND SUBSEQUENT SALVAGE INTRAVESICAL THERAPY

Abstract

You have accessJournal of UrologyBladder Cancer: Non-invasive IV (MP73)1 Apr 2020MP73-13 MULTI-INSTITUTIONAL OUTCOMES OF PATIENTS WITH HIGH-RISK NON-MUSCLE INVASIVE BLADDER CANCER (NMIBC) WHO UNDERGO RADICAL CYSTECTOMY AFTER BCG AND SUBSEQUENT SALVAGE INTRAVESICAL THERAPY Vignesh T. Packiam*, Craig V. Labbate, Stephen A. Boorjian, Robert F. Tarrell, Brittany Adamic, Mohammad Mahmoud, Matvey Tsivian, Svetlana Avulova, John C. Cheville, R. Jeffrey Karnes, Matthew K. Tollefson, Ryan P. Werntz, Gary D. Steinberg, and Igor Frank Vignesh T. Packiam*Vignesh T. Packiam* More articles by this author , Craig V. LabbateCraig V. Labbate More articles by this author , Stephen A. BoorjianStephen A. Boorjian More articles by this author , Robert F. TarrellRobert F. Tarrell More articles by this author , Brittany AdamicBrittany Adamic More articles by this author , Mohammad MahmoudMohammad Mahmoud More articles by this author , Matvey TsivianMatvey Tsivian More articles by this author , Svetlana AvulovaSvetlana Avulova More articles by this author , John C. ChevilleJohn C. Cheville More articles by this author , R. Jeffrey KarnesR. Jeffrey Karnes More articles by this author , Matthew K. TollefsonMatthew K. Tollefson More articles by this author , Ryan P. WerntzRyan P. Werntz More articles by this author , Gary D. SteinbergGary D. Steinberg More articles by this author , and Igor FrankIgor Frank More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000959.013AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are multiple ongoing salvage intravesical therapy (SIT) trials for patients with NMIBC who do not respond to BCG. However, oncologic outcomes for patients who fail SIT are not well established. Herein, we evaluate the impact of SIT on survival in patients with NMIBC previously treated with BCG who ultimately underwent radical cystectomy (RC). METHODS: We performed a retrospective review of two institutional RC registries to identify patients with NMIBC who received at least 1 complete induction course of BCG and subsequently underwent RC for bladder cancer between 2000-2018. Patients were stratified by receipt of SIT following BCG prior to RC. Oncologic outcomes were compared using Cox proportional hazards regression analysis and the Kaplan-Meier method. For sensitivity analysis, patients with SIT were matched 1:3 by presenting tumor stage to patients without SIT. RESULTS: We identified a total of 371 patients who underwent RC after receiving BCG, of whom 55 (15%) received SIT, most commonly Mitomycin C (n=26), Valrubicin (n=8), Gemcitabine (n=7), and CG0070 (n=6). Median follow-up among survivors was 1.1 (IQR 0-4.3) years, during which time 149 died, including 79 from bladder cancer. Age, race, BMI, and Charlson Comorbidity Index were similar between groups. Patients who received SIT were more likely to initially present with CIS (27% vs 17%) and less likely to present with T1 disease (33% versus 50%, both p<0.05). Receipt of SIT was not associated with increased risk of adverse pathology (≥pT2 or pN+) at RC (33% versus 41%, p=0.27). Furthermore, on Kaplan-Meier analysis, receipt of SIT was not associated with cancer-specific or overall survival. On multivariable Cox proportional hazards regression analysis, clinical stage prior to RC, but not receipt of SIT, was associated with inferior cancer-specific survival and overall survival (Table 1). On matched analysis, SIT remained without association with survival outcomes. CONCLUSIONS: Our results suggest that RC following SIT after BCG is not associated with inferior oncologic outcomes. While careful management should continue to be used in this setting, these data can improve counseling for patients considering SIT trials. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1126-e1127 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vignesh T. Packiam* More articles by this author Craig V. Labbate More articles by this author Stephen A. Boorjian More articles by this author Robert F. Tarrell More articles by this author Brittany Adamic More articles by this author Mohammad Mahmoud More articles by this author Matvey Tsivian More articles by this author Svetlana Avulova More articles by this author John C. Cheville More articles by this author R. Jeffrey Karnes More articles by this author Matthew K. Tollefson More articles by this author Ryan P. Werntz More articles by this author Gary D. Steinberg More articles by this author Igor Frank More articles by this author Expand All Advertisement PDF downloadLoading ...