PD44-09 IMPACT OF HIGH-RISK FEATURES AND STAGING ON NEOADJUVANT CHEMOTHERAPY AMONG PATIENTS TREATED WITH RADICAL CYSTECTOMY: A SINGLE CENTER ANALYSIS OF 1700 CASES

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD44-09 IMPACT OF HIGH-RISK FEATURES AND STAGING ON NEOADJUVANT CHEMOTHERAPY AMONG PATIENTS TREATED WITH RADICAL CYSTECTOMY: A SINGLE CENTER ANALYSIS OF 1700 CASES Shreyas Naidu, Roger Li, Wenyi Fan, Kyle Rose, Heather Huelster, Aram Vosoughi, Scott Gilbert, Daniel Grass, Rohit Jain, Youngchul Kim, Brandon Manley, Michael Poch, Julio Pow-Sang, Philippe Spiess, Alice Yu, Logan Zemp, Jingsong Zhang, and Wade Sexton Shreyas NaiduShreyas Naidu More articles by this author , Roger LiRoger Li More articles by this author , Wenyi FanWenyi Fan More articles by this author , Kyle RoseKyle Rose More articles by this author , Heather HuelsterHeather Huelster More articles by this author , Aram VosoughiAram Vosoughi More articles by this author , Scott GilbertScott Gilbert More articles by this author , Daniel GrassDaniel Grass More articles by this author , Rohit JainRohit Jain More articles by this author , Youngchul KimYoungchul Kim More articles by this author , Brandon ManleyBrandon Manley More articles by this author , Michael PochMichael Poch More articles by this author , Julio Pow-SangJulio Pow-Sang More articles by this author , Philippe SpiessPhilippe Spiess More articles by this author , Alice YuAlice Yu More articles by this author , Logan ZempLogan Zemp More articles by this author , Jingsong ZhangJingsong Zhang More articles by this author , and Wade SextonWade Sexton More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003354.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Neoadjuvant chemotherapy (NAC) followed by radical cystectomy with pelvic lymph node dissection (RC) has convincingly demonstrated improvement in survival and consequently been established as the new standard-of-care for muscle invasive bladder cancer (MIBC). Due to its toxicity, multi-agent platinum-based chemotherapy has been variably adopted in the neoadjuvant setting. In this study, we report the long-term outcomes from our institutional experience with the use of NAC in MIBC patients METHODS: 1700 patients who underwent RC at Moffitt Cancer Center between July 2004 and October 2020 for bladder cancer were retrospectively reviewed. Patients received presurgical chemotherapy and radical cystectomy (PC) or underwent upfront radical cystectomy with no chemotherapy (NC). cT2 patients were sub-stratified as high-risk (HR) or low-risk (LR) using the MDACC risk criteria including the presence of hydronephrosis, LVI, prostatic urethral involvement, and variant histology. RESULTS: 761 PC and 805 NC patients were retrospectively identified with complete baseline information. Amongst 461 NC patients with ≥cT2 disease, 118 (25%) achieved pathologic downstaging<pT2N0 and 38 (8.2%) pCR. In comparison, 244 (35.8%) PC patients with ≥cT2 disease achieved pathologic downstaging (p<0.001) and 135 (19.8%) pCR (p<0.0001). Stratified by clinical T-stage, only cT2 patients derived OS (Median 62.3mo vs. 41.9mo, p<0.001) benefit. To further categorize the characteristics associated with superior chemotherapeutic response, we sub-stratified the cT2 patients according to the MDACC risk criteria. While the use of PC in low-risk (LR) cT2 patients did not significantly increase downstaging (42.7% vs. 34.4%) or pCR (23.5% vs. 11.9%) rates, dramatic increases were seen in the high risk (HR) cT2 patients undergoing PC (downstaging 41.6% vs. 19.4%, p<0.0001; pCR 23.5% vs. 6.9%, p<0.0001). CONCLUSIONS: Pathologic response rates to PC were modest compared to those previously reported in randomized controlled trials and only cT2 patients derived OS benefit among those that received PC. Upon further analysis it was found that following stratification using the MDACC risk criteria, only HR cT2 patients obtained a benefit from presurgical chemotherapy. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1128 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shreyas Naidu More articles by this author Roger Li More articles by this author Wenyi Fan More articles by this author Kyle Rose More articles by this author Heather Huelster More articles by this author Aram Vosoughi More articles by this author Scott Gilbert More articles by this author Daniel Grass More articles by this author Rohit Jain More articles by this author Youngchul Kim More articles by this author Brandon Manley More articles by this author Michael Poch More articles by this author Julio Pow-Sang More articles by this author Philippe Spiess More articles by this author Alice Yu More articles by this author Logan Zemp More articles by this author Jingsong Zhang More articles by this author Wade Sexton More articles by this author Expand All Advertisement PDF downloadLoading ...