Cystectomy For Muscle-invasive Bladder Cancer Research Articles

Comparison of outcomes between trimodal therapy and radical cystectomy in muscle-invasive bladder cancer: a propensity score matching analysis.

Although radical cystectomy (RC) is considered as the standard therapy for muscle-invasive bladder cancer (MIBC), trimodal therapy (TMT) combining transurethral resection of the tumor with radiotherapy and chemotherapy is increasingly recommended as an alternative approach for bladder preservation. In the absence of randomized trials, we compared the clinical outcomes between RC and TMT using propensity score matching with 50 patients in the RC arm and 29 patients in the TMT arm. With respective median follow-up periods of 23 and 32 months for the RC and TMT groups, 5-year distant metastasis-free survival (58% vs. 67%), overall survival (56% vs. 57%), and cancer-specific survival (69% vs. 63%) rates between the RC and TMT groups, respectively, were similar. However, the 5-year local recurrence-free survival was significantly better in the RC group than in the TMT group (74% vs. 35%). Following TMT, acute grade 3 hematological (n = 2) and late grade 3 genitourinary (n = 1) toxicities were reported. These findings demonstrated that oncological outcomes of TMT were comparable with those of RC, except for poorer local control. Large-scale, randomized trials are warranted to confirm the findings of the present retrospective comparison and to guide toward best treatment options.

A reported 20-gene expression signature to predict lymph node-positive disease at radical cystectomy for muscle-invasive bladder cancer is clinically not applicable.

BackgroundNeoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) provides a small but significant survival benefit. Nevertheless, controversies on applying NAC remain because the limited benefit must be weight against chemotherapy-related toxicity and the delay of definitive local treatment. Therefore, there is a clear clinical need for tools to guide treatment decisions on NAC in MIBC. Here, we aimed to validate a previously reported 20-gene expression signature that predicted lymph node-positive disease at radical cystectomy in clinically node-negative MIBC patients, which would be a justification for upfront chemotherapy.MethodsWe studied diagnostic transurethral resection of bladder tumors (dTURBT) of 150 MIBC patients (urothelial carcinoma) who were subsequently treated by radical cystectomy and pelvic lymph node dissection. RNA was isolated and the expression level of the 20 genes was determined on a qRT-PCR platform. Normalized Ct values were used to calculate a risk score to predict the presence of node-positive disease. The Cancer Genome Atlas (TCGA) RNA expression data was analyzed to subsequently validate the results.ResultsIn a univariate regression analysis, none of the 20 genes significantly correlated with node-positive disease. The area under the curve of the risk score calculated by the 20-gene expression signature was 0.54 (95% Confidence Interval: 0.44-0.65) versus 0.67 for the model published by Smith et al. Node-negative patients had a significantly lower tumor grade at TURBT (p = 0.03), a lower pT stage (p<0.01) and less frequent lymphovascular invasion (13% versus 38%, p<0.01) at radical cystectomy than node-positive patients. In addition, in the TCGA data, none of the 20 genes was differentially expressed in node-negative versus node-positive patients.ConclusionsWe conclude that a 20-gene expression signature developed for nodal staging of MIBC at radical cystectomy could not be validated on a qRT-PCR platform in a large cohort of dTURBT specimens.

264 - 20-gene expression signature to predict lymph node positive disease at radical cystectomy for muscle-invasive bladder cancer: Not validated

264 - 20-gene expression signature to predict lymph node positive disease at radical cystectomy for muscle-invasive bladder cancer: Not validated

Adjuvant Radiotherapy Use by US Radiation Oncologists After Radical Cystectomy for Muscle-invasive Bladder Cancer

AimsHistoric trials suggested significant toxicity with adjuvant radiotherapy (ART) after radical cystectomy for muscle-invasive bladder cancer (MIBC). However, recent trials have found improved locoregional control and the 2016 National Comprehensive Cancer Network (NCCN) guidelines recommend ART consideration for select patients at high risk of local recurrence. ART practice patterns among US radiation oncologists are unknown and we carried out a survey to explore current trends. Materials and methodsWe conducted a survey of US radiation oncologists regarding the management of patients with cT2-3N0M0 transitional cell MIBC. Responses were reported using descriptive statistics. Chi-square and univariate logistic regression of clinical and demographic covariates were conducted, followed by multivariable logistic regression analysis to identify factors predicting for ART use. ResultsIn total, 277 radiation oncologists completed our survey. Nearly half (46%) have used ART for MIBC at least once in the past. In ART users, indications for ART include gross residual disease (93%), positive margins (92%), pathological nodal involvement (64%), pT3 or T4 disease (46%), lymphovascular invasion (16%) and high-grade disease (13%). On univariate logistic regression, ART use was associated with the number of years in practice (P=0.04), pre-cystectomy radiation oncology consultation (P=0.004), primarily treating MIBC patients fit for cystectomy (P=0.01) and intensity-modulated radiotherapy use (P=0.01). On multivariable logistic regression analysis, routine pre-cystectomy radiation oncology consultation (odds ratio 1.91, 95% confidence interval 1.04–3.51; P=0.04) and intensity-modulated radiotherapy use (odds ratio 2.77, 95% confidence interval 1.48–5.22; P=0.002) remained associated with ART use. ConclusionsART use is controversial in bladder cancer, yet unexpectedly has commonly been used among US radiation oncologists treating patients with MIBC after radical cystectomy. NRG-GU001 was a randomised trial in the US randomizing patients with high-risk pathological findings for observation or ART after cystectomy. However, due to poor accrual it recently closed and thus it will be up to other international trials to clarify the role of ART and identify patients benefiting form this adjuvant therapy.

Adjuvant radiotherapy use after radical cystectomy in muscle-invasive bladder cancer: A survey of U.S. radiation oncologists.

369 Background: Historic trials suggested significant toxicity with adjuvant radiotherapy (ART) after radical cystectomy for muscle-invasive bladder cancer (MIBC). However, recent trials have found improved locoregional control and the 2016 NCCN guidelines recommend ART consideration for select patients at high risk of local recurrence. ART practice patterns among U.S. radiation oncologists (ROs) are unknown, and we performed a survey to explore current trends. Methods: We conducted a survey of U.S. ROs regarding the management of patients with cT2-3N0M0 transitional cell MIBC. Responses were reported using descriptive statistics. Chi-square and univariate logistic regression (UVA) of clinical and demographic covariates were conducted, followed by multivariable logistic regression analyses (MVA) to identify factors predicting for ART use. Results: 277 ROs completed our survey. Nearly half (46%) use ART for MIBC. In ART-users, indications for ART include gross residual disease (93%), positive margins (92%), pathologic nodal involvement (64%), pT3 or T4 disease (46%), lymphovascular invasion (16%), and high-grade disease (13%). On UVA, ART use was associated with the number of years in practice (p=.043), pre-cystectomy RO consultation (p=0.004), primarily treating MIBC patients fit for cystectomy (p=0.009), and intensity-modulated radiotherapy (IMRT) use (p=0.009). On MVA, routine pre-cystectomy RO consultation (odds ratio [OR] 1.91, 95% confidence interval [CI]: 1.04-3.51; p=.037) and IMRT use (OR 2.77, 95% CI: 1.48-5.22; p=.002) remained associated with ART use. Conclusions: ART use is controversial in bladder cancer, yet is unexpectedly commonly used among U.S. radiation oncologists treating patients with MIBC after radical cystectomy. NRG GU001 is a randomized trial currently accruing patients with high-risk pathologic findings for observation or ART after cystectomy, and will hopefully clarify the role of ART and help identify patients benefiting from this adjuvant therapy. Whenever possible, patients should be enrolled in this study.

Change in Psoas Muscle Volume as a Predictor of Outcomes in Patients Treated with Chemotherapy and Radical Cystectomy for Muscle-Invasive Bladder Cancer.

Objective: Sarcopenia, or the age-related loss of skeletal muscle mass and function, has been investigated as a potential marker of adverse outcomes among surgical patients. Our aim was to assess for changes in psoas muscle volume (PMV) following administration of neoadjuvant chemotherapy (NAC) in patients with bladder cancer and to examine whether changes in PMV following NAC are predictive of perioperative complications, pathologic response or survival.Methods: During the period of 2009–2013, patients undergoing NAC and radical cystectomy (RC) at our institution with pre and post NAC cross sectional images available were included. Bilateral total psoas muscle volume (PMV) was obtained from pre- and post- NAC images and the proportion of PMV change was calculated by dividing the change PMV by pre-NAC PMV. Analyses for the assessment of factors predicting PMV loss, partial/complete pathologic response (pPR/pCR), complications, readmission, cancer specific (CSS), recurrence-free (RFS) and overall survival (OS) were performed.Results: Total of 60 patients had complete radiological data available. Post-NAC PMV and BMI declines were statistically significant, 4.9% and 0.05%, respectively. NAC dose reduction/delay was a significant predictor of PMV loss (coefficient B 4.6; 95% CI 0.05–9.2; p = 0.047). The proportion of PMV decline during NAC was not a predictor of pPR, pCR, complications, readmission, CSS, RFS, or OS.Conclusions: We observed an interval decline in PMV during the period of NAC administration and this decline was more than it could be appreciated with changes in BMI during the same period. PMV decline was associated with the need for dose reduction/dose delay during NAC. In our series, PMV changes occurring during NAC administration were not predictive of pathologic response to chemotherapy, postoperative complications or survival.

794P - Impact of race on survival following radical cystectomy for muscle-invasive bladder cancer (MIBC): Analysis of the US National Cancer Database (NCDB)

794P - Impact of race on survival following radical cystectomy for muscle-invasive bladder cancer (MIBC): Analysis of the US National Cancer Database (NCDB)

76. Circulating tumor cells in patients undergoing radical cystectomy for muscle-invasive bladder cancer: Interim results of the CirGuidance study

76. Circulating tumor cells in patients undergoing radical cystectomy for muscle-invasive bladder cancer: Interim results of the CirGuidance study

Impact of body mass index on the oncological outcomes of patients treated with radical cystectomy for muscle-invasive bladder cancer.

Body mass index (BMI) has been associated with worse outcomes in several solid malignancies. We aimed to evaluate the association between BMI and oncological outcomes in patients treated with radical cystectomy (RC) for muscle-invasive urothelial carcinoma of the bladder (UCB). We retrospectively reviewed 701 consecutive patients treated with RC and pelvic lymphadenectomy for UCB at our institution between 1995 and 2011. Univariable and multivariable Cox regression models investigated the association of BMI with disease recurrence and cancer-specific mortality. BMI was analyzed as both continuous and categorical variable (<25 vs. 25-29 vs. ≥30kg/m2). From the 701 patients, 275 (39.2%) had a BMI<25kg/m2, 280 (39.9%) had a BMI between 25 and 29.9kg/m2, and 146 (20.9%) had a BMI⩾30kg/m2. Within a median follow-up of 45months (IQR 23-75), 163 patients (23.3%) experienced a disease recurrence and 127 (18.1%) died from the disease. In univariable analyses, BMI⩾30kg/m2 was associated with a higher risk of disease recurrence and cancer-specific mortality (both p values <0.01). In multivariable analyses that adjusted for the effects of standard clinicopathological features, BMI⩾30kg/m2 was associated with both higher risks of disease recurrence (HR 1.58; 95% CI 1.06-2.34, p=0.02) and cancer-specific mortality (HR 1.58; 95% CI 1.01-2.48; p=0.04). Obesity was independently associated with higher risks of disease recurrence and cancer-specific mortality in patients treated with RC for muscle-invasive UCB. BMI is a modifiable feature that may have significant individual and public health implications in patients with muscle-invasive UCB.

Frequency and clinical implications of pathologic complete response (pCR) at cystectomy for muscle-invasive bladder cancer (MIBC) with or without neoadjuvant chemotherapy (NAC).

383 Background: Subsets of patients (pts) with MIBC, with or without NAC, have no pathologic evidence of disease at cystectomy. The frequency and implications of pCR in “real world” pts has not been well characterized. Methods: Using the National Cancer Database, pts with cT2-4aN0M0 bladder cancer who underwent cystectomy alone (CYS) or with NAC from 2003-2011 were identified. pCR was defined as pT0N0M0. In the CYS and NAC cohorts, the association between pCR and overall survival was analyzed using Cox proportional hazard methods. Results: 12,245 pts met eligibility (CYS: 10,940; NAC: 1,305). The pCR rate with CYS was 4.8% (95% CI 4.4-5.3%) and with NAC was 21.6% (95% CI 19.4-24.0%). In both cohorts, logistic regression revealed lower cT stage and higher cystectomy volume were associated with increased pCR. pCR was associated with a significant improvement in survival in both cohorts (Table). Conclusions: The frequency of pCR in real world pts was substantially lower than reported in clinical trials; however, pCR was associated with markedly improved survival in both CYS and NAC groups. Molecular predictors of pCR in both groups warrant evaluation. Whether the survival benefit associated with pCR in the CYS cohort simply reflects the “smallest/best” tumors or whether there is a role, and mechanistic rationale, for surgical approaches to increase pCR (i.e., re-TURBT in MIBC) warrants study. Finally, our findings lend further support for use of pCR as an endpoint in NAC clinical trials. [Table: see text]

Programmed Death-Ligand 1 Expression in Muscle-Invasive Bladder Cancer Cystectomy Specimens and Lymph Node Metastasis: A Reliable Treatment Selection Biomarker?

BackgroundThe programmed death-1 (PD-1) pathway negatively regulates T-cell activation and has an important role in regulating antitumor host immunity. Monoclonal antibodies directed against PD-1 or the PD-1 ligand (PD-L1) have shown activity in several tumor types with preliminary data suggesting a relationship between PD-L1 expression and response. The aim of this study was to establish the frequency of PD-L1 expression in muscle-invasive bladder cancer and associated lymph node metastasis using immunohistochemistry and to investigate the feasibility of using PD-L1 expression as a biomarker to select patients for PD–1-directed therapy. Patients and MethodsCases of radical cystectomy for muscle-invasive bladder cancer with no exposure to previous chemotherapy were identified and representative slides from archived paraffin-embedded blocks stained with anti–PD-L1 antibody (5H1 clone) were identified. PD-L1 positivity was defined by a 5% expression threshold. ResultsFifty-two radical cystectomy specimens were reviewed. PD-L1 was overexpressed in the tumor cells of 5/52 (9.6%) of cystectomy specimens in this cohort with 17/52 (32.7%) of cases showing PD-L1 overexpression in tumor-infiltrating immune cells. Discordance was observed between PD-L1 expression in lymph node metastasis and the primary tumor. ConclusionStandard assays for PD-L1 expression have yet to be established. The observation of discordance between PD-L1 expression in metastatic sites and primary tumors suggests that prospective biomarker studies should aim to acquire material immediately before treatment initiation rather than archived tissue from resected specimens that might not reflect the current immune-active microenvironment.

Not Available

Among patients undergoing radical cystectomy for muscle-invasive bladder cancer, local and distant recurrence is the main reason for cancer-related deaths. In case of adrenal location of metachronous metastases, the standard treatment consists on cisplatin-based systemic chemotherapy. While surgical removal of metastasis remains controversial approach, more and more data support such treatment as effective and safe. We report two cases of patients submitted to laparoscopic adrenalectomy as a sole treatment mode due to metachronous metastases of bladder cancer. No adjuvant systemic therapy was implemented. After a follow-up of 12 months patients remain disease free. This report is another voice in the on-going debate on the role of surgical treatment of patients with metastatic bladder cancer.

A Single-centre Early Phase Randomised Controlled Three-arm Trial of Open, Robotic, and Laparoscopic Radical Cystectomy (CORAL)

BackgroundLaparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) are increasingly popular, but high-level evidence for these techniques remains lacking. ObjectiveTo compare the outcomes of patients undergoing open radical cystectomy (ORC), RARC, and LRC. Design, setting, and participantsFrom March 2009 to July 2012, 164 patients requiring radical cystectomy for muscle-invasive bladder cancer or high-risk non–muscle-invasive bladder cancer were invited to participate, with an aim of recruiting 47 patients into each arm. Overall, 93 were suitable for trial inclusion; 60 (65%) agreed and 33 (35%) declined. InterventionORC, RARC, or LRC with extracorporeal urinary diversion. Outcome measurements and statistical analysisPrimary end points were 30- and 90-d complication rates. Secondary end points were perioperative clinical, pathologic, and oncologic outcomes, and quality of life (QoL). The Fisher exact test and analysis of variance were used for statistical analyses. Results and limitationsThe 30-d complication rates (classified by the Clavien-Dindo system) varied significantly between the three arms (ORC: 70%; RARC: 55%; LRC: 26%; p=0.024). ORC complication rates were significantly higher than LRC (p<0.01). The 90-d complication rates did not differ significantly between the three arms (ORC: 70%; RARC: 55%; LRC 32%; p=0.068). Mean operative time was significantly longer in RARC compared with ORC or LRC. ORC resulted in a slower return to oral solids than RARC or LRC. There were no significant differences in QoL measures. Major limitations are the small sample size and potential surgeon bias. ConclusionsThe 30-d complication rates varied by type of surgery and were significantly higher in the ORC arm than the LRC arm. There was no significant difference in 90-d Clavien-graded complication rates between the three arms. Patient summaryWe compared patients having open, robotic, or laparoscopic bladder removal surgery for bladder cancer and found no difference in Clavien-graded complication rates at 90 d.

Predictors of referral for neoadjuvant chemotherapy prior to radical cystectomy for muscle-invasive bladder cancer and changes in practice over time.

In patients with non-metastatic muscle-invasive bladder cancer (MIBC) fit for curative therapy, a multidisciplinary approach consisting is recommended. This approach includes local treatment (usually radical cystectomy), ideally combined with neoadjuvant chemotherapy (NACT). Despite a survival benefit with NACT, uptake remains low. We assessed NACT consultation in Alberta and examined associative factors, as well as the relationship to survival. Patients with MIBC were identified through the Alberta Cancer Registry. Demographic and clinicopathologic information was collected from electronic medical records between 2007 and 2011. In addition to descriptive statistics, logistic regression was used to determine factors associated with receiving NACT consultation. Overall survival was described using a Kaplan-Meier estimate. Of the 315 radical cystectomy patients, 140 (45.1%, 95% confidence interval [CI] 39.5, 50.8) received NACT consultation. Patients ≥80 years (odds ratio [OR] 0.21, 95% CI 0.08, 0.57, p = 0.002) and those treated in Calgary (OR 0.11, 95% CI 0.05, 0.25, p < 0.001) were less likely to receive NACT consultation. The rate of NACT consultation increased steadily from 2007 to 2011 (OR 1.23, 95% CI 1.04, 1.45 per year of diagnosis, p = 0.018). After a median follow-up of 28.1 months (range: 14.6-50.3), median survival was 54.7 months for patients who received NACT consultation versus 31.2 months for those who did not (p = 0.030). NACT consultation in patients with MIBC undergoing radical cystectomy has improved over time; however, regional differences underscore the need for a standardized approach to NACT consultation, including common referral mechanisms.

Neoadjuvant chemotherapy administration and time to cystectomy for muscle-invasive bladder cancer: An evaluation of transitions between academic and community settings

ObjectivesNeoadjuvant chemotherapy (NAC) before radical cystectomy is the standard of care for muscle-invasive bladder cancer (MIBC). Many patients are referred to an academic medical center (AMC) for cystectomy but receive NAC in the community setting. This study examines if administration of NAC in the community is associated with differences in type of NAC received, pathologic response rate (pT0), and time to cystectomy as compared to NAC administered at an AMC. MethodsWe performed a retrospective study of patients with MIBC (cT2a-T4-Nx-M0) referred to a single AMC between 1/2012 and 1/2014 who received NAC. We analyzed chemotherapy received, time to cystectomy, pT0, and survival in patients who received NAC in our AMC compared to those treated in the community. ResultsIn all, 47 patients were analyzed. A similar total dose of cisplatin (median: 280mg/m2 for both groups, P = 0.82) and pT0 rate (25% vs. 29%, P = 0.72) were seen in patients treated in our AMC and the community. However, administration of NAC in the community was associated with a prolonged time to cystectomy compared with that in our AMC (median number of days 162 vs. 128, P<0.01). This remained significant after adjusting for stage, comorbidity status, and distance to the AMC (P = 0.02). Disease-free survival and overall survival did not differ. ConclusionPatients with MIBC treated with NAC in the community as compared to an AMC received similar chemotherapy and achieved comparable pT0 rates, indicating effective implementation of NAC in the community. However, NAC in the community was associated with longer time to cystectomy, suggesting a delay in the transition of care between settings.

MP72-07 NOMOGRAM PREDICTING CANCER SPECIFIC MORTALITY (CSM) AFTER NEOADJUVANT CHEMOTHERAPY AND RADICAL CYSTECTOMY FOR MUSCLE-INVASIVE BLADDER CANCER (BC): RESULTS OF AN INTERNATIONAL CONSORTIUM

You have accessJournal of UrologyBladder Cancer: Invasive V1 Apr 2015MP72-07 NOMOGRAM PREDICTING CANCER SPECIFIC MORTALITY (CSM) AFTER NEOADJUVANT CHEMOTHERAPY AND RADICAL CYSTECTOMY FOR MUSCLE-INVASIVE BLADDER CANCER (BC): RESULTS OF AN INTERNATIONAL CONSORTIUM Maria Carmen Mir, Cesar Ercole, and Andrew Stephenson Maria Carmen MirMaria Carmen Mir More articles by this author , Cesar ErcoleCesar Ercole More articles by this author , and Andrew StephensonAndrew Stephenson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2641AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Neoadjuvant chemotherapy with multi-agent cisplatin-based regimens for invasive bladder cancer is associated with improved all-cause and cancer-specific mortality from randomized trials. The post-chemotherapy pathological stage has previously been reported to be a major determinant of outcome. We endeavored to develop a postoperative nomogram for survival based on these and other parameters from an international consortium. METHODS Between the years 2000 and 2013, 1130 patients with cT2-4a N0 M0 carcinoma of the bladder were treated at 19 institutions in USA, Canada, and Europe. Standard chemotherapy regimens (MVAC, GC) and non-standard regimens were administered in 1020 (90%) and 110 (10%) patients, respectively. The median number of cycles received was 3 (IQR: 3-4). Using multivariable Cox regression analysis, we constructed a model to predict cancer-specific mortality RESULTS The overall 5-year CSM was 62% (95% CI, 58%-66%). Significant variables in the model were lymph node metastasis (p<0.001), pathological stage (p<0.001), positive surgical margins (p<0.001) and chemotherapy regimen (p=0.0106). The resultant nomogram was internally validated and had a concordance index of 0.76. According to pathological stage, the 5-year CSM was 84.5% (95%CI, 79%-89%) for pT0, 79.3% (95%CI, 72%-86%)for pTIS-T1, 70% (95%CI, 62%-80%) for pT2, 31% (95%CI, 25%-39%)for pT3-4a, and 20.8% (95%CI, 14%-28%)for pN1-3. CONCLUSIONS We have developed and validated a nomogram predicting CSM after neoadjuvant chemotherapy and radical cystectomy for invasive bladder cancer. The nomogram will be useful for patient counseling and in the identification of patients at high-risk for subsequent disease progression suitable for enrollment in clinical trials of adjuvant therapy. Chemo regimen: 1- MVAC; 2-GC; 3- Gem-Carboplatin © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e923 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Maria Carmen Mir More articles by this author Cesar Ercole More articles by this author Andrew Stephenson More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Alternatives to cystectomy

In many cases radical cystectomy is not feasible in patients suffering from muscle-invasive bladder cancer due to advanced age of the patient or limiting comorbidities which increase the perioperative risk. A further group of patients decline radical cystectomy due to potential postoperative complications and the resulting impairment in the quality of life. This article provides an overview of alternative therapeutic concepts to radical cystectomy in muscle-invasive bladder cancer. The study involved a database analysis and gives a discussion of clinical trials concerning alternative therapeutic concepts for muscle-invasive bladder cancer treatment strategies. Transurethral resection, open partial cystectomy, radiotherapy, chemotherapy and combined therapeutic regimens are available as alternatives to radical cystectomy. Radical cystectomy is the accepted standard of care in the treatment of muscle-invasive bladder cancer but in selected patients, established alternative methods can also be offered. A comprehensive patient information and counseling is therefore necessary to find the best therapeutic option in each individual case. Salvage cystectomy is a therapeutic option in cases of failure of organ-preserving treatment.

Concurrent urologic and palliative care after cystectomy for treatment of muscle-invasive bladder cancer

PurposeTo characterize the effect of palliative care provided concurrently with usual urologic care for patients with bladder cancer undergoing cystectomy. Materials and methodsProspective, 6-month, serial cohort study comparing 33 participants receiving usual care with cystectomy for muscle-invasive bladder cancer, with 30 participants also receiving concurrent palliative care. Patients and family caregivers completed validated symptom assessment and satisfaction surveys preoperatively and at 2, 4, and 6 months postoperatively. ResultsThe intervention group saw improvements in most symptom measures over the 6 months following cystectomy compared with the control group. Depression and anxiety decreased over the 6-month period for the intervention group patients but increased over this time among the controls (P = 0.01). Fatigue decreased to a minimum for the intervention group participants at 4 months, whereas it peaked at this time for control participants (0.002). Quality-of-life and posttraumatic growth scores followed a similar pattern, with scores peaking at 4 months for the intervention group whereas controls reported their lowest scores at this time (P = 0.01 and P = 0.03, respectively). Changes in pain scores did not reach statistical significance. Neither family caregiver burden nor patient satisfaction showed statistically significant changes over time. ConclusionsPatients who received concurrent palliative care in addition to usual urologic care following radical cystectomy for muscle-invasive bladder cancer had better outcomes, including improved fatigue, depression, quality of life, and posttraumatic growth. Although further research on this topic is needed, our results suggest that providing palliative care services in addition to usual urologic care for patients with bladder cancer may significantly reduce postoperative symptoms.

735 Nomogram predicting cancer specific mortality (CSM) after neoadjuvant chemotherapy and radical cystectomy for muscle-invasive bladder cancer (BC): Results of an international consortium

735 Nomogram predicting cancer specific mortality (CSM) after neoadjuvant chemotherapy and radical cystectomy for muscle-invasive bladder cancer (BC): Results of an international consortium

Concurrent Urologic and Palliative Care after Cystectomy for Treatment of Muscle-Invasive Bladder Cancer (FR467-A)

Objectives List the severity of baseline physical and emotional symptoms for patients preoperatively before cystectomy as definitive treatment for muscle-invasive bladder cancer. Describe the outcomes associated with the addition of palliative care offered concurrently in addition to usual care for muscleinvasive bladder cancer. Describe the impact on family caregivers of palliative care offered concurrently with usual care for patients with muscleinvasive bladder cancer. Original Research Background: assessed, and few interventions have been prospectively evaluated using validated instruments. In particular palliative care offered concurrently with surgical oncologic care for patients with bladder cancer has not been studied. Research Objectives: To characterize the impact of palliative care concurrent with usual urologic care for bladder cancer patients undergoing cystectomy. Methods: Prospective, 6-month, serial cohort study comparing 33 participants receiving usual care with cystectomy for muscleinvasive bladder cancer with 30 participants also receiving concurrent palliative care. Patients and family caregivers completed validated symptom assessment and satisfaction surveys preoperatively and 2, 4, and 6 months postoperatively. Results: The intervention group saw improvements in most symptom measures over the 6 months following cystectomy compared with the control group. Depression and anxiety decreased over the 6-month period for intervention patients but increased over this time among controls (p=0.01). Fatigue fell to a minimum for intervention group participants at 4 months, while it peaked at this time for control participants (0.002). Quality of life and posttraumatic growth scores followed a similar pattern, with scores peaking at 4months for the intervention group, while controls reported their lowest scores at this time (p=0.01 and p=0.03, respectively). Changes in pain scores did not reach statistical significance. Neither family caregiver burden nor patient satisfaction showed statistically significant changes over time. Conclusions: Patients who received concurrent palliative care in addition to usual urologic care following radical cystectomy for