MP78-11 ONCOLOGICAL OUTCOMES WITH NEOADJUVANT CHEMOTHERAPY AND CYSTECTOMY FOR MALE PATIENTS WITH CT4A UROTHELIAL BLADDER CANCER

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive VI1 Apr 2018MP78-11 ONCOLOGICAL OUTCOMES WITH NEOADJUVANT CHEMOTHERAPY AND CYSTECTOMY FOR MALE PATIENTS WITH CT4A UROTHELIAL BLADDER CANCER Jian Chen, Gus Miranda, Jie Cai, Siamak Daneshmand, and Hooman Djaladat Jian ChenJian Chen More articles by this author , Gus MirandaGus Miranda More articles by this author , Jie CaiJie Cai More articles by this author , Siamak DaneshmandSiamak Daneshmand More articles by this author , and Hooman DjaladatHooman Djaladat More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2559AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although level 1 evidence suggest that neoadjuvant chemotherapy (NAC) improves the outcomes of muscle invasive bladder cancer, the benefit of NAC to patients with prostatic stromal invasive bladder cancer (T4a) remains uncertain. We present the oncological outcomes of male patients with cT4a bladder cancer managed with NAC followed by radical cystectomy (RC). METHODS Data were collected retrospectively from male patients with cT4a bladder cancer, who underwent RC with or without NAC. Patient demographics, disease profile, and pathological response were compared. The Kaplan-Meier method and multivariable Cox regression analysis were used to analyze recurrence free survival (RFS) and overall survival (OS). RESULTS From 1989 to 2016, 90 male patients with cT4a urothelial bladder cancer underwent RC at our institute, 55 (61%) had RC alone, 35 (39%) had NAC+RC. There were no significant differences between groups regarding age, comorbidities or hydronephrosis. NAC+RC group had more lymphovascular invasion (LVI) on primary transurethral resection (31.4 vs 18.2%, p=0.2) and more clinically positive nodal disease (31.4 vs 10.9%, p=0.09). At RC, the tumor down staging rate was 60% for NAC+RC group, compared to 29.1% for RC alone group (OR=3.66 (95%CI 1.50-8.92), p=0.005). Also, NAC+RC group had significant less LVI (40 vs 54.5%, OR=0.56 (95%CI 0.17-0.93), p=0.05) and less positive nodal disease (25.7 vs 45.5%, OR=0.42 (95%CI 0.16-0.89), p=0.006). Patients with tumor down staging had improved RFS and OS (Figure). Multivariable Cox regression modeling showed that, hydronephrosis, LVI, and age>70 were associated with worse RFS and OS (p<0.05). After controlling for hydronephrosis, LVI, and age>70, tumor down staging was associated with significantly lower risk of disease recurrence (HR=0.27 (95%CI 0.11-0.64), p=0.003) and overall death (HR=0.48 (95%CI 0.25-0.93), p=0.03). NAC alone was not associated with lower risk of disease recurrence (HR=1.99 (95%CI 0.93-4.24), p=0.08) or overall death (HR=1.53, (95%CI 0.83-2.82), p=0.18). CONCLUSIONS NAC is associated with cT4a bladder cancer down staging, decreased LVI and decreased positive nodal disease. NAC provides survival benefit to those who achieve pathological response. It is imperative to identify predictors of NAC response. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1041 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Jian Chen More articles by this author Gus Miranda More articles by this author Jie Cai More articles by this author Siamak Daneshmand More articles by this author Hooman Djaladat More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...