PD09-09 SURVIVAL BENEFITS OF ADJUVANT CHEMOTHERAPY FOR POSITIVE SOFT TISSUE SURGICAL MARGINS FOLLOWING RADICAL CYSTECTOMY IN BLADDER CANCER WITH EXTRAVESICAL EXTENSION

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD09-09 SURVIVAL BENEFITS OF ADJUVANT CHEMOTHERAPY FOR POSITIVE SOFT TISSUE SURGICAL MARGINS FOLLOWING RADICAL CYSTECTOMY IN BLADDER CANCER WITH EXTRAVESICAL EXTENSION Prithvi Murthy, Shreyas Naidu, Facundo Davaro, Philippe Spiess, Logan Zemp, Michael Poch, Rohit Jain, Aram Vosoughi, Alice Yu, Wade Sexton, Scott Gilbert, and Roger Li Prithvi MurthyPrithvi Murthy More articles by this author , Shreyas NaiduShreyas Naidu More articles by this author , Facundo DavaroFacundo Davaro More articles by this author , Philippe SpiessPhilippe Spiess More articles by this author , Logan ZempLogan Zemp More articles by this author , Michael PochMichael Poch More articles by this author , Rohit JainRohit Jain More articles by this author , Aram VosoughiAram Vosoughi More articles by this author , Alice YuAlice Yu More articles by this author , Wade SextonWade Sexton More articles by this author , Scott GilbertScott Gilbert More articles by this author , and Roger LiRoger Li More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003240.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Locally advanced muscle invasive bladder cancer is an aggressive disease entity that requires multimodal therapy. However, the benefits of adjuvant chemotherapy (AC) in patients with a positive soft-tissue surgical margin (STSM) are relatively unknown. We sought to define survival benefits in this cohort in our institutional bladder cancer database. METHODS: We performed a retrospective review of all patients undergoing radical cystectomy for urothelial carcinoma of the bladder at Moffitt Cancer Center from 2004-2020 with gross extravesical (≥pT3b) disease irrespective of neoadjuvant chemotherapy (NAC) use or pathologic lymph node metastases. Overall survival estimates were obtained using the Kaplan-Meier method with log-rank test and the Cox-proportional hazards model was used to identify predictors of overall survival. AC was defined by any chemotherapy use within 90 days of cystectomy, regardless of STSM status. RESULTS: 441 patients with pT3b disease or worse and adjuvant chemotherapy data were identified. Baseline clinicodemographic information are listed in Table 1. Positive STSM (HR 1.90, 1.42-2.53, 95% CI, p<0.001) and AC use (HR 0.63, 0.47-0.84, 95% CI, p=0.002) were significantly associated with poorer overall survival when adjusted for pathologic T-stage, N-stage, performance status and NAC use. On subgroup analysis, as shown in Figure 1, the use of AC in patients with a positive STSM improved median OS from 6 months [4-8, 95% CI] to 16 months [11-53, 95% CI] (p<0.01). In patients with a negative soft-tissue surgical margin, the median survival with AC was 22 months [17-37, 95% CI] compared to 16 months [14-20, 95% CI] without (p=0.14). ECOG performance status, NAC use, rates of pathologic nodal involvement, and LVI did not differ by AC use in the entire cohort or based on STSM status. CONCLUSIONS: Adjuvant chemotherapy may particularly benefit patients with positive STSM following radical cystectomy for gross extravesical disease. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e243 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Prithvi Murthy More articles by this author Shreyas Naidu More articles by this author Facundo Davaro More articles by this author Philippe Spiess More articles by this author Logan Zemp More articles by this author Michael Poch More articles by this author Rohit Jain More articles by this author Aram Vosoughi More articles by this author Alice Yu More articles by this author Wade Sexton More articles by this author Scott Gilbert More articles by this author Roger Li More articles by this author Expand All Advertisement PDF downloadLoading ...