PD51-10 COMPETING MORTALITY IN BLADDER CANCER PATIENTS AFTER CYSTECTOMY: THE ROLE OF SECOND NON-UROTHELIAL CANCERS

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive III (PD51)1 Sep 2021PD51-10 COMPETING MORTALITY IN BLADDER CANCER PATIENTS AFTER CYSTECTOMY: THE ROLE OF SECOND NON-UROTHELIAL CANCERS Patrick Hensley, Zhigang Duan, Kelly Bree, Akshay Sood, Andrea Kokorovic, Hui Zhao, Charles Guo, Neema Navai, Colin Dinney, and Ashish Kamat Patrick HensleyPatrick Hensley More articles by this author , Zhigang DuanZhigang Duan More articles by this author , Kelly BreeKelly Bree More articles by this author , Akshay SoodAkshay Sood More articles by this author , Andrea KokorovicAndrea Kokorovic More articles by this author , Hui ZhaoHui Zhao More articles by this author , Charles GuoCharles Guo More articles by this author , Neema NavaiNeema Navai More articles by this author , Colin DinneyColin Dinney More articles by this author , and Ashish KamatAshish Kamat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002078.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Muscle-invasive bladder cancer (MIBC) is associated with considerable disease- and treatment-related morbidity and mortality and is often diagnosed in heavily co-morbid patients. With improved surgical techniques and therapeutic options, survivorship in MIBC patients is of emerging relevance. We investigate the role of second non-urothelial cancer (SNUC) as a competing mortality risk factor in post-radical cystectomy (RC) patients. METHODS: An IRB-approved study of patients who underwent RC for cT2-3 MIBC from 2005-2018 was performed. The site and timing of biopsy-proven SNUC was recorded. Patients with less than 24-months of post-operative follow-up, those with non-melanoma cutaneous malignancies, and incidental prostate cancer were excluded. The cumulative incidence of SNUC and mortality were estimated with modified Kaplan-meier analysis. RESULTS: Median follow-up time for the 468 patients who underwent RC was 5.0 years (IQR 3.4-7.1 years). SNUC developed in 70 (15.0%) patients at a median 3.0 years (IQR 1.3-5.5 years) from RC with a cumulative incidence of SNUC at 3, 5 and 10 years after RC 7.2%, 11.4% and 23.5%, respectively. The most common sites for SNUC were lung (N=20, 4.3%) and hematologic malignancies (N=15, 3.2%). Bladder cancer surveillance imaging identified 70.0% of lung cancers and 62.5% of gastrointestinal cancers. Compared to lung cancers identified during symptomatic workup, those found on surveillance were more commonly stage 1 (78.6% vs. 16.7%, p=0.018) and non-lethal (64.3% vs. 16.6%, p=0.141). Bladder cancer mortality was surpassed by other-cause mortality as the leading cause of death 8 years after RC (Figure). The 15-year cumulative risk of mortality was: 21.0% for bladder cancer (95% CI 13.1%-30.1%), 10.5% for SNUC (95% CI 6.5%-15.7%), and 34.5% for other-cause (95% CI 21.6%-47.7%). CONCLUSIONS: SNUC developed in 15% of post-RC patients, with the majority identified on surveillance imaging. Other-cause mortality surpassed that of bladder cancer mortality in year 8 after RC. These data have clinical significance with regards to patient counseling, survivorship and oncologic surveillance in the highly co-morbid MIBC population. Source of Funding: Urology Care Foundation Research Scholars Award to PJH (IRG 85-001-25); Wayne B. Duddlesten Professorship and the Raymond and Maria Floyd Bladder Cancer Research Foundation Grant to AMK © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e909-e909 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Patrick Hensley More articles by this author Zhigang Duan More articles by this author Kelly Bree More articles by this author Akshay Sood More articles by this author Andrea Kokorovic More articles by this author Hui Zhao More articles by this author Charles Guo More articles by this author Neema Navai More articles by this author Colin Dinney More articles by this author Ashish Kamat More articles by this author Expand All Advertisement Loading ...