Invasive Urinary Bladder Cancer Research Articles

Prognostic value of isolated tumor cells and micrometastasis of lymph nodes in invasive urinary bladder cancer.

The prognostic significance of nodal micrometastasis and isolated tumor cells (ITC) in urinary bladder cancer (UBC) is unknown. We aimed to evaluate the prevalence, clinical impact, and clinicopathological characteristics of nodal micrometastasis and ITC in UBC. A total of 124 patients with UBC undergoing surgery were investigated. Detection of micrometastasis and ITC was performed using pancytokeratin immunohistochemistry (IHC). Histopathologic and clinical findings were correlated with patients' outcome. IHC detected nodal micrometastasis and ITC (pNmi group) in 12.9% (13/101) of originally node-negative patients and in 26.1% (6/23) of originally node-positive patients (pN+ group). The remaining 88 were truly node-negative patients (pN0 group). After IHC, all 13 patients in the pNmi group were upstaged from pN0 to pN1-2 and one patient in the pN+ group was changed from pN1 to pN2. Nodal micrometastasis and ITC were significantly associated with mixed urothelial carcinoma (UC) (p = 0.002), UC with discohesive pattern (p = 0.006), glandular differentiation (p = 0.043), lymphovascular invasion (p = 0.009), and budding-like tumor cell clusters (p = 0.002). The pNmi group had significantly worse cancer-specific survival than the pN0 group in univariate (p = 0.004) and multivariate (p = 0.040) analysis. IHC frequently identified nodal micrometastasis and ITC in originally node-negative UBC patients on routine pathological examination. Nodal micrometastasis and ITC were independently associated with cancer-related mortality in UBC. IHC might be selectively used to detect micrometastasis and ITC in UBC having specific pathological features.

Relationship Between Availability of Urologists and Primary Care Providers and Stage of Diagnosis for Invasive Urinary Bladder Cancer.

With no recommended screening approach, urinary bladder cancer patients rely on referral to urologists to ensure timely diagnosis of bladder cancer. This requires coordination between primary and specialty care. We provide estimates of the relative association between primary care physician and urologist density on stage of urinary bladder cancer diagnosis. We used 2010 to 2016 Pennsylvania Cancer Registry data to identify all adult patients diagnosed with bladder cancer. Our primary outcome was locoregional stage of diagnosis, since treatment modality changes and prognosis worsens beyond this stage. Based on patient's residential location at the time of diagnosis we defined both density of urologists and number of primary care providers (defined as providers per population) within the patient's county. We used univariate and multivariate logistic regression to estimate the association between provider density and likelihood of locoregional stage of diagnosis. We also controlled for age, sex, race/ethnicity, insurance type, and year. Our sample included 11,771 urinary bladder cancer patients with 10,607 diagnosed at locoregional stage and 1164 at distant stage. Multivariate regression results show primary care density was associated with significantly higher odds of locoregional stage of diagnosis (odds ratio of 1.05 [95% CI: 1.02-1.08]) while urologist density was associated with significantly lower odds of locoregional stage (odds ratio of 0.65 [95% CI: 0.48-0.89]). We found primary care density but not urologist density was associated with earlier stage of diagnosis, highlighting the importance of access to primary care and need for timely referral to urologic care.

Impact of HER2 assay sensitivity on the ability to detect tumors with low to ultra-low HER2 expression: A TMA study on more than 10,000 tumors from more than 100 tumor entities

Abstract Introduction/Objective Detection of low level HER2 expression is important for therapy with new HER2 inhibitors in breast cancer. HER2 assays with high sensitivity are therefore needed. These may identify low level HER2 expression in various types other than breast cancer. Methods/Case Report A tissue microarray containing >10,000 tissue samples from more than 100 different tumor types and subtypes was analyzed for immunohistochemical expression of HER2 using different immunohistochemistry protocols and anti-HER2 antibodies, including the HercepTest and laboratory developed tests designed for high sensitivity. HER2 IHC evaluation included the recording of HER2 low (1+), ultralow (any staining, less than 1+), and 0 (negative). Results (if a Case Study enter NA) Irrespective of the assay sensitivity all assays showed the expected/tolerable association with HER2 FISH data in 308 breast cancers. In non-breast cancers, the use of different assays yielded variable rates of low or ultra-low HER2 expression in different tumor entities. For example, low (1+) and ultra-low (+) expression was observed in 7-24% (1+) and 11-28% (+) of serous ovarian cancers, 6.2-24% (1+) and 3.4-19% (+) of endometrioid endometrial cancers, 5.5-14% (1+) and 7.7-13% (+) of intestinal gastric cancers, 1.8-9.2% (1+) and 4.5- 11% (+) of ductal adenocarcinomas of the pancreas, 19-33% (1+) and 5.5-11% (+) of muscle invasive urinary bladder cancers, 2.9-16% (1+) and 4.3-12% (+) of adenocarcinomas of the colon. Conclusion Low level HER2 expression occurs commonly in many cancer types. The rate of identifiable tumors with HER2 low or HER2 ultra-low expression varies depending on assay parameters that can easily be modified. Irrespective of assay sensitivity, our data identify various tumor entities with significant fractions of “HER2-low” cases that might benefit from therapy with new antibody drug conjugates.

HMG co-reductase expression and response to intravesical Bacillus Calmette-Guérin in patients with high grade non-muscle invasive urinary bladder cancer receiving statins.

Cardiovascular disease affects over 7 million people in the UK and statins are often prescribed to mitigate cardiovascular risks. The effect of statins on a number of cancers is debated and their effect on Bacillus Calmette-Guérin (BCG) responsiveness in non-muscle invasive urinary bladder cancer (NMIBC) is not fully understood. This study aims to explore the difference in HMG Co-A reductase (HMGCR) expression in NMIBC on immunochemistry in BCG responders and non-responders while on statins. Three hundred and thirty-two cases of intravesical BCG treatment for high-risk NMIBC between November 2003 and December 2017 were identified. Patients taking statins for at least 12 months before the diagnosis of NIMBC and with a follow-up of at least 5 years were included. They were divided into BCG responders and non-responders. Tumour tissue from these patients was immunohistochemically stained and quantitative image analysis carried out to assess and compare HMGCR expression in the groups. This study showed a differential expression of HMGCR in responders vs. non-responders to BCG for high-risk NMIBC on statins. This data should form the basis of a further research and multi-centre study in a larger cohort, using HMGCR as a biomarker of response in patients on statins.

Multiparametric MRI in differentiation between muscle invasive and non-muscle invasive urinary bladder cancer with vesical imaging reporting and data system (VI-RADS) application: Our initial experience

Multiparametric MRI in differentiation between muscle invasive and non-muscle invasive urinary bladder cancer with vesical imaging reporting and data system (VI-RADS) application: Our initial experience

SC29 - Multiparametric MRI in differentiation between muscle invasive and non-muscle invasive urinary bladder cancer with vesical imaging reporting and data system (VI-RADS) application: our initial experience

SC29 - Multiparametric MRI in differentiation between muscle invasive and non-muscle invasive urinary bladder cancer with vesical imaging reporting and data system (VI-RADS) application: our initial experience

Abstract 5130: Prognostic significance of loss of Cathepsin L expression in urinary bladder cancer progression

Abstract During 2021 there will be 83,730 new cases of urinary bladder cancer (UBC) in the US and 17,200 UBC deaths. Most UBC arise from the urothelial lining. UBC frequently recurs and is the most expensive cancer to treat due to the need for constant patient monitoring. New prognostic markers are needed to assist patient management. This study aims to determine if Cathepsin L is an independent prognostic factor after controlling for UBC Stage and Grade. We studied the interrelationship of Cathepsin L with Ki67, a prognostic marker in UBC. A clearer understanding of the biological mechanisms underlying UBC development and progression will lead to improved methods of UBC prognosis and suggest new therapies. Cathepsin L is a ubiquitously expressed cysteine endopeptidase capable of degrading enzymes, receptors, and transcription factors, and of activating enzymes, receptors, biologically active peptides, and pro-hormone processing by limited proteolysis. Subcellularly located in the endosomal lysosomal compartment, Cathepsin L is catalytically active at pH 3.0 - 6.5. This is a retrospective study of archived tissues and existing deidentified medical records and tumor registry information. Archived FFPE tissues were donated to Wood Hudson Cancer Research Laboratory by St. Elizabeth Healthcare (SEHC). The study was approved by the SEHC IRB. Tumors were from 41 women and 92 men. UBC were classified according to subtype, depth of invasion and grade by a Board Certified pathologist (LED). 36/62 (58.1%) of Stage 0 non-invasive UBC were Grade 1 or 2, and 26/62 (41.9%) were Grade 3 or 4. Similarly 39/90 papillary tumors (43.3%) were Grade 1 or 2 and 51/90 (36.7%) were Grade 3 or 4. In contrast 68/71 invasive UBC (Stages II, III and IV) were Grade 3 or 4. 39/90 papillary tumors were Grade 1 or 2. All non-papillary tumors were Grade 3 or 4. Ki 67 (clone MIB-1, Dako) and Cathepsin L (Abcam) expression were detected immunohistochemically. Cathepsin L was highly expressed in normal urothelium (p < 0.0001). In Stage 0, Cathepsin L expression in Grade 1,2,3 UBC was similar compared to expression in normal urothelium (p = 0.9070, 0.2560 and 0.0722). In Stage 0, Cathepsin L expression in Grade 4 UBC was significantly reduced compared to normal urothelium (p = 0.0011). Cathepsin L expression was significantly reduced in Grade 3 and 4 papillary tumors vs Grade 1 and 2 papillary tumors (p = 0.0002) and in Grade 3 and 4 non-papillary tumors vs Grade 3 and 4 papillary tumors (p = 0.0133). In each UBC subtype, grade or stage, when Cathepsin L expression was reduced cell proliferation as measured by Ki67 expression was increased and overall, this was significant (p < 0.0001). Significantly reduced Cathepsin L expression was associated with tumor recurrence and death from UBC (p = 0.03, p < 0.0001). These data suggest that when Cathepsin L is lost, intracellular levels of growth factor receptors such as EGFR may increase driving cell proliferation and UBC progression. Citation Format: Julia H. Carter, James A. Deddens, Michelle C. Robillard, Mariah K. Dooley, Daniel Stelzer, Zachary S. Taylor, Larry E. Douglass. Prognostic significance of loss of Cathepsin L expression in urinary bladder cancer progression [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5130.

Quality of Life, Efficacy, and Safety of Sequential Intravesical Gemcitabine + Docetaxel versus BCG for Non-Muscle Invasive Urinary Bladder Cancer: A Pilot Study

Purpose: Bacille Calmette-Guerin (BCG) is considered the most effective agent for non-muscle invasive bladder cancer (NMIBC). However, due to BCG-related toxicity, multiple studies have suggested the role of newer chemotherapeutic drugs. The aim of our study was to evaluate intravesical gemcitabine + docetaxel (Gem/Doce) versus BCG with respect to quality of life (QOL), safety, and efficacy in NMIBC. Methods: A total of 60 patients with NMIBC were evaluated between July 2019 and December 2020 in a prospective manner. The sample size calculation was done, keeping in mind the incidence of intravesical BCG-related complications of up to 50–60% and 20–30% for Gem/Doce combination. The p value of 0.05 was kept as statistically significant. The enrollment ratio was kept at 1, and power of study was aimed at 80%. The study population was alternatively assigned to two groups (BCG vs. Gem/Doce) of 30 patients each. Both the groups received 6 weekly doses of induction therapy followed by 6 monthly doses of maintenance therapy if no recurrence was noted at interim follow-up. QOL scores, safety, and efficacy were assessed at beginning of intravesical therapy, end of induction, and 6 months of maintenance therapy. Cystoscopy examination and cytology were performed at the end of induction therapy and 3-monthly thereafter. Result: The preliminary results at the end of 6 months following maintenance therapy showed that the demographic profile, histological stage, and grade were comparable between two groups. The QOL scores using QLQ-30 and QLQ-BLS-24 showed statistically significant differences with the Gem/Doce arm showing better outcomes. There were no progressions to higher stage, while one recurrence each was seen in both groups. Patient-related side effects measured by CTCAE (Common Terminology Criteria for Adverse Events)version 5 showed that the BCG group had higher toxicity profile as compared to Gem/Doce group. Conclusion: Gem/Doce combination intravesical therapy is a promising alternative to BCG for treatment of NMIBC, showing better QOL measures and lesser side effects.

EXPRESSION OF OCT-4 STEM CELL MARKER IN URINARY BLADDER CANCER AND ITS CORRELATION WITH INVASIVENESS

This study’s objective is to evaluate the expression of Octamer-binding transcription factor 4 (OCT-4) as a prognostic biomarker for urinary bladder cancer (UBC) along with its histological grade and tissue invasiveness. It is also called the POU domain, class 5, transcription factor I(POU5FI). OCT-4 protein is a transcription factor and a well-known marker of cancer stem cells. This study aimed to validate the OCT-4 value in urinary bladder cancer. FFPE tissue blocks from ten patients of different grades and invasiveness of urothelial carcinoma were studied and correlated with the degree of OCT-4 expression by immunohistochemistry. The mean histochemical expression score in seven high-grade urothelial carcinoma cases was 8.4 as compared to 5.0 in three low-grade urothelial carcinoma cases. Similarly, the mean histochemical expression score in seven lamina invasive urothelial carcinoma was 5.9 as compared to 7.5 in detrusor muscle-invasive urothelial carcinoma. There was a positive correlation between OCT-4 expression and high grade and invasive urinary bladder cancer.

Purulent-inflammatory complications after surgical operations for bladder cancer

Incidence of suppurative-inflammatory comlica- tions after surgical treatment in 618 patients with invasive urinary bladder cancer is studied. The urinary bladder resection is carried out in 306 of them, the cystectomy with various methods of urine removal in 312 of them. The basic suppurative-inflammatory complications in the postoperative period are acute pyelonephritis and peritonitis. After the urinary bladder resection without ureterocystoneostomy the seirous pyelonephritis is found in 8% of the patients, with ureterocysto-neostomy in 37,8% of the patients, the purulent pyelonephritis in 10,1% of the patients. The pyelonephritis and peritonitis complicated the course of cystectomy in 19,3% and 22,7% of the cases, respectively.

A prospective multicenter study of visual response-evaluation by cystoscopy in patients undergoing neoadjuvant chemotherapy for muscle invasive urinary bladder cancer

Purpose To evaluate a method of transurethral visual response-staging in patients with urothelial muscle-invasive urinary bladder cancer (MIBC), undergoing neoadjuvant chemotherapy (NAC) and radical cystectomy (RC). Methods A prospective study at four Swedish cystectomy centers, cystoscopy was performed after final NAC-cycle for MIBC. Fifty-six participants underwent cystoscopy for visual staging of the tumor immediately pre-RC. Visual assessments were correlated to pathoanatomical outcomes post-RC. Results Seventeen tumors were classified as complete response (CR), i.e. pT0. Twenty-five patients had residual MIBC and 14 had non-muscle invasive residual tumors (NMIBC). Of the 39 patients with residual tumor, 25 were correctly identified visually (64%). Eleven patients were pN+. The diagnostic accuracy of cystoscopy to correctly identify complete response or remaining tumor was 70% (CI = 56–81%) with a sensitivity of 64% (CI = 47–79%), specificity 82% (CI = 57–96%), PPV 89% (CI = 74–96%) and NPV 50% (CI =38–61%). Twenty-eight cystoscopy evaluations showed signs of residual tumors and 3/28 (11%) were false positive. In 4/14 patients assessed having residual NMIBC the estimates were correct, 8/14 had histopathological MIBC and 2/14 had CR. In 11/14 patients (79%), the suggested visual assessment of MIBC was correct, 2/14 had NMIBC and 1/14 had CR. Twenty-eight cystoscopies had negative findings, 14 were false negatives (50%), when cystoscopy falsely predicted pT0. Among them there were eight patients with pTa, pT1 or pTis and six MIBC-tumors. In 17 patients with histopathological pT0, 14 were correctly identified with cystoscopy (82%). Conclusion Cystoscopy after the final NAC-cycle cannot robustly differentiate between NAC-responders and non-responders. Visually, negative MIBC-status cannot be determined safely.

Control computerized tomography in neoadjuvant chemotherapy for muscle invasive urinary bladder cancer has no value for treatment decisions and low correlation with nodal status

Background Control computerized tomography (cCT) is routinely used in many cystectomy centres before the final treatment cycle in patients with muscle-invasive urinary bladder cancer (MIBC) undergoing neoadjuvant chemotherapy (NAC). This is for evaluating response or nonresponse to NAC treatment. In a real-world retrospective cohort, we intended to evaluate the frequency of changed individual treatment strategies following cCT and to investigate any discrepancies between cCT-results on nodal staging and final pN-stages. Methods We performed a retrospective data-based, multicenter study of 242 MIBC-patients, staged cT2N0M0-cT4aN0M0, having undergone NAC and radical cystectomy (RC) between 2008 and 2019 at four Swedish cystectomy centres. Statistical analysis was performed using IBM SPSS statistics 26. Results Overall, 139/242 patients were examined with cCT. Six patients were staged as progressive at cCT and 5/139 (3.6%) underwent a change of previously planned treatment strategy. 2/6 patients with suspected progression (33%) did not change strategy and underwent all preplanned NAC-cycles plus RC. Only 1/6 patients assigned as progressive at the cCT, showed progression in the postoperative pathology specimen. In total 133/139 patients were considered being without progress on cCT, yet 28/133 (21%) presented with nodal progression at postoperative pathology examinations. Only 1/29 patients with histopathologically verified nodal dissemination were detected with cCT, thus 28/29 (96.6%) with pN + were undetected. The sensitivity for cCT to predict pTNM was 17% CI [0%–64%] and the specificity was 78% CI [71%–86%]. Conclusions CCT prior to the final treatment cycle of NAC in MIBC, leads to a low percentage of treatment strategy changes and cCT cannot accurately predict pN-status.

Incidence and Predictors of Secondary Upper Tract Urothelial Cancer in Patients with High-Risk Non-Muscle Invasive Urinary Bladder Cancer and its Impact on Imaging Surveillance: A Retrospective Analysis with 1501 Patients

Objectives: We aimed to study the incidence and predictors of upper tract urothelial cancer (UTUC) in patients with high-risk non-muscle invasive bladder cancer (HR-NMIBC). Methods: Patients who had HR-NMIBC were reviewed to identify those who subsequently developed UTUC. Complete transurethral resection was performed, and biopsies were collected for histopathology followed by intravesical chemoimmunotherapy. Patients were screened annually by computed tomography (CT) for UTUC. Results: Data for 1501 patients were reviewed. UTUC developed in 59 (4%) after a median of 20 months after HR-NMIBC. Most patients were symptomatic, but UTUC was discovered on routine follow-up imaging in 28%. On bivariate analysis, only multiple bladder tumors and the number of bladder recurrences were predictors for UTUC (P = 0.01 and P = 0.008, respectively). Multiple bladder tumors and ≥ 3 bladder recurrences remained significant on multivariable analysis. Conclusion: UTUC after HR-NMIBC is uncommon (4%). Despite routine follow-up CT imaging, recurrence was detected due to symptoms in most patients, and based on imaging only in 28%. Imaging surveillance can be prioritized in patients with multiple bladder tumors and those with ≥ 3 bladder recurrences. For the other patients, the benefit of imaging surveillance has to be weighed against the risks.

Bacillus Calmette-Guerin vaccine and bladder cancer incidence: Scoping literature review and preliminary analysis

Background: The Bacillus Calmette-Guerin (BCG) vaccine has long been used for the prevention of tuberculosis (TB) around the world. BCG is also used as an immunotherapy agent for the treatment of non-muscle invasive urinary bladder cancer. This scoping literature review and preliminary data analysis aims to summarize the literature correlating infantile BCG vaccination with the incidence of future bladder cancer. Methods: Studies were identified by a formal literature search of MEDLINE and Cochrane Central Registrar of Controlled Trials following PRISMA guidelines. Preliminary data analysis was conducted on publicly accessible data summarizing the impact of gender, BCG vaccination, and socio-economic effects on crude and age-standardized rates of bladder cancer. Results: As part of our analysis, preliminary regression models demonstrated BCG vaccination status, gender, and socio-economic status to have statistically significant effects on crude and age-standardized rates of bladder cancer incidence. BCG vaccination was associated with a 35-37% lower age-standardized rate of bladder cancer incidence. Conclusions: There is very little literature examining the relationship between prior BCG vaccination and rates of bladder cancer incidence. Our limited data analysis indicates that a relationship does exist between infantile BCG vaccination and later bladder cancer development, although extensive future investigation is needed in this area.

Bacillus Calmette Guerin (BCG) Balanitis: a Rare Organ Complication of Non-muscle Invasive Urinary Bladder Cancer Following Intravesical Immunotherapy

Bacillus Calmette Guerin (BCG) is widely used for prevention of recurrence and progression in non-muscle invasive urinary bladder cancers. However, it is associated with tolerable adverse events ranging from low-grade fever to lower urinary tract symptoms. While majority of complications are minor and local, systemic involvement warrants early treatment with antitubercular agents. Involvement of glans penis is rare with only few cases reported in the literature. We report one such case of BCG balanitis in a 64-year-old male treated with intravesical BCG for non-muscle invasive urinary bladder cancer.

Radical cystectomy compared to intravesical BCG immunotherapy for high-risk non-muscle invasive bladder cancer – is there a long-term survival difference? A Swedish nationwide analysis

Objectives High-risk non-muscle invasive urinary bladder cancer (NMIBC) presents an increased risk of progression and cancer death. To reduce these risks, two different treatments are recommended – BCG or radical cystectomy (RC). The purpose of this study is to analyze cancer-specific survival of these two initial treatments. Materials and Methods BladderBaSe links information from the SNRUBC from 1997 to 2014, with a number of national healthcare and demographic registers. BCG was used for 3,862 patients (399 had delayed RC), while 687 had initial RC. Propensity scores were used to match the patients treated with RC and with relevant variables such as age, gender, and tumor stage with the same number treated with BCG (673 each arm). In a further comparison, an instrumental variable analysis using hospital strategy as the instrument was used. Results The 5-year cancer-specific survival chance was higher for the BCG group than it was for the initial RC group, 87 vs 71%, respectively. In the population with propensity score matching, 78 died from cancer in the BCG group during follow-up and 162 in the RC group. In the instrumental variable analysis, the multivariate adjusted risk difference of cancer-specific death 2 years after diagnosis was 32 per 100 treated patients, in favor of the BCG group. Conclusions BCG therapy had better cancer-specific survival than RC also when two different statistic methods were used to try to control for confounding. A prospective randomized trial will be necessary to rule out that selection is a major factor for the outcome.

Chloride Intracellular Channel Protein 1 (CLIC1) Ιs Over-expressed in Muscle Invasive Urinary Bladder Cancer.

Invasive bladder cancer mortality remains high despite progresses made in early diagnosis and surgical procedures. Thus, there is a need to define new markers for bladder cancer. CLIC1 has not been previously studied in bladder cancer and thus, we aimed to assess its immunohistochemical expression in relation to different stages of bladder cancer development. Immunohistochemistry for CLIC1 was applied in 50 cases of muscle invasive bladder cancer. CLIC1 was not expressed in the normal urothelium, but a strong reaction was observed in dysplastic urothelium, carcinoma in situ and in 94% of the cases with invasive urothelial carcinoma; however, it was not expressed in squamous cell carcinoma cases. No correlation was found between the immunohistochemical expression of CLIC1 and the stage and grade of the tumour. CLIC1 was overexpressed in urinary bladder dysplastic epithelium, carcinoma in situ and invasive carcinoma. CLIC1 constitutes a new potential marker of invasive bladder cancer.

205P A study on organ preservation in muscle invasive urinary bladder cancer patients with intensity modulated radiotherapy and concurrent single agent cisplatin in south Indian population

The standard care for muscle invasive bladder carcinoma (MIBC) in the United States for a long time was radical cystectomy where as in Europe, it is radical radiotherapy or multidrug regimen neoadjuvant chemotherapy followed by radiotherapy. In spite of the importance in terms of incidence, prognosis and cost, bladder cancer research remains significantly underfunded so the studies and data on organ preservation in MIBC in India are less explored. We analyzed the data of 30 patients of MIBC from 2016-2018 who underwent primary transurethral resection of bladder tumour (TURBT) followed by IMRT with 64.8 Gy and weekly cisplatin at dose of 40 mg/ m2 with median follow up of 10 months. The role of various factors like tumour stage, histopathology, grade, complete TURBT, obstructive uropathy on locoregional response and disease free survival was evaluated. Local reactions evaluated using CTCAE criteria version 5.0. Statistical analysis was done using SPSS version 23.0. Table: 205PDemographic and disease characteristicsAgeMedian – 68 Yrs Range – 52 - 80 YrsSexMale – 86.7% (n=26) Female – 13.3% (n=4)TurbtComplete – 33.3% (n=10) Incomplete – 66.7% (n=20)HistopathologyTransitional – 86.6%(n=26) Squamous – 6.7% (n=2) Adeno CA – 6.7% (n=2)GradeGrade I – 6.7% (n=2) Grade II – 26.6% (n=8) Grade III - 66.7% (n=20)Tumour StageT2 – 53.3 % (n=16) T3 – 33.3 % (n=10) T4 – 13.4 % (n=4)Obstructive UropathyPresent – 33.3 % (n=10) Absent – 66.7% (n=20)Locoregional ResponseComplete – 73.3% (n=22) Partial – 20% (n=6) Progression – 6.7% (n=2) Open table in a new tab After the treatment, the complete locoregional response (LRR) was 73.3%. Early (T2 stage) tumours (p= 0.043) and patients without obstructive uropathy (p= 0.039) have shown significant LRR. Patients with complete TURBT, Low grade tumours shown increased response though statistically not significant. The overall disease free survival in this study for the preserved bladder patients is 53.3%. Patients without obstructive uropathy have shown significant DFS of 70% (p=0.026). Improved DFS of patients with T2 stage tumours (75%), complete TURBT (60%), low grade tumours was observed though statistically not significant. GU toxicities like dysuria, burning micturition in 40% of patients, increased frequency of micturition in 20% of patients, gastro intestinal toxicities like constipation (40%), pain abdomen (6.7%) were observed during followup and all these are grade I,II and managed well with supportive treatment. Bladder preservation in more than 70% of patients in this study supports the general concept of organ sparing treatment in oncology. The high response rate and DFS were observed in south Indians with complete TURBT, early stage tumours, no obstructive uropathy and low grade tumours. The genito urinary & gastro intestinal toxicities are comparatively less, probably in view of using IMRT technique and single agent cisplatin.

Mini-laparatomy radical cysto-prostatectomy for urinary bladder carcinoma

Introduction: Open radical cysto-prostatectomy (RCP) is the gold standard for invasive urinary bladder cancer in male. Though minimal invasive technique like laparoscopic or robotic assisted surgery is gaining popularity for surgical management in developed countries, open mini laparotomy is equally effective with similar oncological outcome and morbidity result. Our study aims to evaluate the feasibility of Mini-laparotomy RCP with ileal conduit (IC) or neobladder.
 Methods: This is a descriptive cross-sectional study of 25 patients conducted from October 2016 to December 2019. Nineteen patients had muscle invasive urinary bladder cancer (MIBC), four had multifocal high grade non-muscle invasive bladder cancer (NMIBC) and two were BCG failure patients. Nineteen patients underwent RCP with IC and six with RCP and ileal Neobladder. We analyzed technical difficulty, operative time, blood loss, peri-operative complication for minilaparotomy RCP.
 Results: The mean age of patients was 63.2 years (46-81years). The mean operative time was 274 minute (180-420 minutes) with mean blood loss of 470 ml (300-2000 ml). Mean post-operative ileus was observed for 2.8 days (2-4 days). All patients stayed in the hospital for mean days of 12.84 (7 to 25 days). All patients were mobilized early with mean intensive care unit (ICU) stay of 2.52 days. Mean lymph node extraction was 17.6. Two patients died of renal failure and hyperosmolar diabetes mellitus.
 Conclusion: Minilaparatomy RCP is a feasible option in terms of early recovery with acceptable morbidity without compromising the oncological principles.

PT355 - Incidence and predictors of upper urothelial cancer recurrence in patients with non-muscle invasive urinary bladder cancer: A retrospective analysis with 1570 patients at a tertiary urology institute

PT355 - Incidence and predictors of upper urothelial cancer recurrence in patients with non-muscle invasive urinary bladder cancer: A retrospective analysis with 1570 patients at a tertiary urology institute