PD51-01 EVOLVING TRENDS IN SURGICAL AND ONCOLOGIC OUTCOMES FOLLOWING RADICAL CYSTECTOMY: LONG-TERM EXPERIENCE AT THE UNIVERSITY OF SOUTHERN CALIFORNIA

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive III (PD51)1 Sep 2021PD51-01 EVOLVING TRENDS IN SURGICAL AND ONCOLOGIC OUTCOMES FOLLOWING RADICAL CYSTECTOMY: LONG-TERM EXPERIENCE AT THE UNIVERSITY OF SOUTHERN CALIFORNIA Anirban P. Mitra, Jie Cai, Gus Miranda, Sumeet Bhanvadia, Monish Aron, Mihir M. Desai, David I. Quinn, Anne K. Schuckman, Hooman Djaladat, Inderbir S. Gill, and Siamak Daneshmand Anirban P. MitraAnirban P. Mitra More articles by this author , Jie CaiJie Cai More articles by this author , Gus MirandaGus Miranda More articles by this author , Sumeet BhanvadiaSumeet Bhanvadia More articles by this author , Monish AronMonish Aron More articles by this author , Mihir M. DesaiMihir M. Desai More articles by this author , David I. QuinnDavid I. Quinn More articles by this author , Anne K. SchuckmanAnne K. Schuckman More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , Inderbir S. GillInderbir S. Gill More articles by this author , and Siamak DaneshmandSiamak Daneshmand More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002078.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are conflicting reports on outcome trends after radical cystectomy (RC) for bladder cancer (BC). Recent univariate results of a large single-center RC series reported improved outcomes coinciding with neoadjuvant chemotherapy (NAC) use. We assessed management and outcome trends following RC at the University of Southern California across historical and contemporary patient groups where management paradigms evolved over time. METHODS: BC patients who underwent RC with intent to cure between 1971 and 2018 at our institution were analyzed. Clinical course, perioperative management and pathologic characteristics were evaluated using univariable and multivariable models. Trends were assessed across decades. RESULTS: The cohort included 3,347 patients (80% males; median age, 68 years; median follow up, 10 years). Open RC was performed in 71% of cases in the last decade although the trend for robotic RC rose since 2009. There was an overall downtrend in ileal conduit diversion and higher proportion of neobladders (p<0.001). While our pelvic lymphadenectomy template has been the same since 1980s, specimen submission changed to anatomic packets in 2002 with consequent increase in nodal yield (p<0.001). NAC use increased with time with concomitant decrease in adjuvant chemotherapy (AC); this was notable in the last decade (p<0.001) that coincided with improved ypT0 rate (p=0.013). Patients receiving NAC and AC were younger and had more advanced disease (p≤0.005). NAC was associated with longer time to RC (median, 6.2 versus 2.7 months; p<0.001), and not associated with margin status (p=0.46). Median 5-year recurrence-free (RFS) and overall survival (OS) probabilities were 65% and 55%, respectively. Advanced stage, NAC, AC, delay to RC and positive margins were univariably associated with poor outcomes (all, p<0.001; confirmed by multivariable analysis). RFS did not change across decades (p=0.73) but OS improved with time (5-year probability, 1990-99 51%, 2010-18 62%; p=0.019). Among patients with extravesical and/or node-positive disease at RC, those who previously received NAC had worse RFS and OS than those who directly underwent RC (p≤0.001). CONCLUSIONS: Despite recent increase in NAC use and improved ypT0 rates, there has been no overall change in RFS after RC over time, although OS rates have improved. Our stable RFS rates mirror contemporary outcomes at large academic centers. While patients who are downstaged after NAC derive great benefit, it is critical to identify those who may not respond and may have worse outcomes after RC. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e905-e905 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anirban P. Mitra More articles by this author Jie Cai More articles by this author Gus Miranda More articles by this author Sumeet Bhanvadia More articles by this author Monish Aron More articles by this author Mihir M. Desai More articles by this author David I. Quinn More articles by this author Anne K. Schuckman More articles by this author Hooman Djaladat More articles by this author Inderbir S. Gill More articles by this author Siamak Daneshmand More articles by this author Expand All Advertisement Loading ...