PD63-04 ALL HIGH-GRADE NMIBC IS HIGH RISK: BCG RESPONSE IN HIGH-GRADE TA TUMORS

Abstract

You have accessJournal of UrologyBladder Cancer: Non-invasive III (PD63)1 Sep 2021PD63-04 ALL HIGH-GRADE NMIBC IS HIGH RISK: BCG RESPONSE IN HIGH-GRADE TA TUMORS Kelly Bree, Nathan Brooks, Graciela Nogueras-Gonzalez, Supriya Nagaraju, H. Barton Grossman, Neema Navai, Colin Dinney, and Ashish Kamat Kelly BreeKelly Bree More articles by this author , Nathan BrooksNathan Brooks More articles by this author , Graciela Nogueras-GonzalezGraciela Nogueras-Gonzalez More articles by this author , Supriya NagarajuSupriya Nagaraju More articles by this author , H. Barton GrossmanH. Barton Grossman 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.0000000000002107.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: According to the AUA/SUO Guideline on treatment of non-muscle invasive bladder cancer (NMIBC), not all patients with high-grade (HG) tumors are classified as high risk with solitary HG Ta lesions ≤3cm classified as intermediate risk (IR-Ta). The EAU guidelines, however, recommend all HG tumors be classified as high risk. We investigated the response to BCG in all Ta tumors and compared response based on classification as intermediate or high risk category. METHODS: An IRB approved review of patients with NMIBC who received adequate BCG, as defined by the US FDA and the International Bladder Cancer Group, at our institution from 2000-2018 was performed. Patients were then stratified by stage, grade, and AUA risk category. RESULTS: Of 522 patients who received adequate BCG, 234 (44.8%) had Ta tumors. 190 had HG Ta tumors- of these, 55 were AUA IR-Ta, while 135 had AUA high risk (HR-Ta). Oncologic behavior of IR-Ta tumors was more in alignment with their HR-Ta counterparts than low-grade Ta (LG Ta) intermediate risk tumors with respect to: BCG unresponsiveness (LG Ta 7.8% vs IR-Ta 13.0% vs HR-Ta 14.9%, p=0.475), progression to muscle invasive bladder cancer (MIBC) or distant metastasis (LG Ta 0.0% vs. IR-Ta 5.6% vs. HR-Ta 7.4%, p=0.118) and need for radial cystectomy (LG 3.9% vs IR-Ta 12.7% vs HR-Ta 11.9%, p=0.231). Recurrence rates were similar across groups (30.9-40.9%, p=0.550). CONCLUSIONS: In all HG Ta patients treated with adequate BCG, irrespective of size or multiplicity, rates of BCG unresponsiveness and progression (particularly to MIBC or metastasis) were similarly higher than LG Ta tumors. These data support the current EAU risk stratification model and suggest that all HG Ta lesions should be considered high risk. Source of Funding: This research was supported by the Wayne B. Duddlesten Professorship in Cancer Research 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: e1139-e1139 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kelly Bree More articles by this author Nathan Brooks More articles by this author Graciela Nogueras-Gonzalez More articles by this author Supriya Nagaraju More articles by this author H. Barton Grossman 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 ...