MP83-07 RADICAL CYSTECTOMY FOR CLINICAL T1 BLADDER CANCER: DOES TIMING MATTER?

Abstract

You have accessJournal of UrologyBladder Cancer: Non-invasive II1 Apr 2018MP83-07 RADICAL CYSTECTOMY FOR CLINICAL T1 BLADDER CANCER: DOES TIMING MATTER? Akbar Ashrafi, Matthew Winter, Giovanni Cacciamani, Shane Pearce, Gus Miranda, Jie Cai, Andre de Castro Abreu, Hooman Djaladat, Siamak Daneshmand, Mihir Desai, Inderbir Gill, and Monish Aron Akbar AshrafiAkbar Ashrafi More articles by this author , Matthew WinterMatthew Winter More articles by this author , Giovanni CacciamaniGiovanni Cacciamani More articles by this author , Shane PearceShane Pearce More articles by this author , Gus MirandaGus Miranda More articles by this author , Jie CaiJie Cai More articles by this author , Andre de Castro AbreuAndre de Castro Abreu More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , Siamak DaneshmandSiamak Daneshmand More articles by this author , Mihir DesaiMihir Desai More articles by this author , Inderbir GillInderbir Gill More articles by this author , and Monish AronMonish Aron More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2755AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The optimal treatment for clinical stage T1 (cT1) bladder cancer is controversial. The aim of this study was to review the oncological outcomes of patients undergoing early cystectomy (EC) versus those who had delayed cystectomy (DC) for cT1 bladder cancer. METHODS We performed a review of our IRB approved database of all patients undergoing radical cystectomy for cT1 bladder cancer between 2000 to 2016. Our inclusion criteria was patients with a diagnosis of cT1 bladder cancer with detrusor muscle in the transurethral resection specimen (n=198). EC was defined as cystectomy within 90 days of first diagnosis of cT1 bladder cancer, and DC was cystectomy after 90 days. Kaplan-Meier curves and multivariable Cox regression models were used to determine the association between timing of cystectomy and survival. RESULTS 103 underwent EC, while 95 patients underwent DC. Median follow-up was 44 months (range 2-164 months). There were no differences in age, ASA score, BMI, or Charlson comorbidity score between EC and DC. The DC group were more likely to have had prior intravesical therapy (32% vs 5%, p<0.01). Peri-operatively, there was no difference in estimated blood loss (850 vs 774mL), surgical approach (open cystectomy 86 vs 85%), operating time (6 vs 6 hours), total resected nodes (51 vs 56), length of stay (8 vs 8 days), 30-day or 90-day complications (45% vs 49%, and 55% vs 60%). The EC group was more likely to have carcinoma-in-situ (71% vs 48%, p=0.04) and multifocal tumors (45% vs 31%, p=0.04), and less likely to be have pathological upstaging to pT2+ on cystectomy (27% vs 31%, p=0.03) on cystectomy compared to DC. There were no differences between EC and DC in terms lymph node positive disease (7% vs 8%), positive surgical margins (4% vs 6%) or adjuvant chemotherapy (13% vs 6%). Kaplan-Meier analysis demonstrated improved RFS and OS in patients undergoing early cystectomy (p=0.061 and p=0.045 respectively, Figure 1). On Cox regression analysis, delayed cystectomy was an independent predictor for recurrence (HR 2.6, p=0.025). CONCLUSIONS Radical cystectomy within 90 days of diagnosis of clinical T1 bladder cancer is associated with improved overall survival compared to delayed cystectomy, and delay to cystectomy is an independent predictor of recurrence. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1118 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Akbar Ashrafi More articles by this author Matthew Winter More articles by this author Giovanni Cacciamani More articles by this author Shane Pearce More articles by this author Gus Miranda More articles by this author Jie Cai More articles by this author Andre de Castro Abreu More articles by this author Hooman Djaladat More articles by this author Siamak Daneshmand More articles by this author Mihir Desai More articles by this author Inderbir Gill More articles by this author Monish Aron More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...