Mp77-10 Residual Cancer at Radical Cystectomy With or Without Neoadjuvant Chemotherapy for Clinical T2 Muscle-Invasive Bladder Cancer: A Pathologic Stage-Matched Comparison

You have accessJournal of UrologyBladder Cancer: Invasive VI (MP77)1 May 2024MP77-10 RESIDUAL CANCER AT RADICAL CYSTECTOMY WITH OR WITHOUT NEOADJUVANT CHEMOTHERAPY FOR CLINICAL T2 MUSCLE-INVASIVE BLADDER CANCER: A PATHOLOGIC STAGE-MATCHED COMPARISON Leilei Xia, Daniel S. Roberson, Erika L. Wood, Anosh Dadabhoy, Everett Knudsen, Sofia Romano, Thomas J. Guzzo, Trinity J. Bivalacqua, and Siamak Daneshmand Leilei XiaLeilei Xia , Daniel S. RobersonDaniel S. Roberson , Erika L. WoodErika L. Wood , Anosh DadabhoyAnosh Dadabhoy , Everett KnudsenEverett Knudsen , Sofia RomanoSofia Romano , Thomas J. GuzzoThomas J. Guzzo , Trinity J. BivalacquaTrinity J. Bivalacqua , and Siamak DaneshmandSiamak Daneshmand View All Author Informationhttps://doi.org/10.1097/01.JU.0001009404.49693.12.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While neoadjuvant chemotherapy (NAC) is recommended for localized muscle-invasive bladder cancer (MIBC), approximately 70% of patients will have residual cancer after NAC. The data is still limited on whether patients with residual cancer at RC following NAC have poorer outcomes compared to those with residual cancer post-RC without NAC. METHODS: We used the National Cancer Database (2006-2018) to identify patients with clinical T2N0M0 urothelial bladder cancer who underwent RC with or without NAC. The primary outcome was overall survival (OS). We compared outcomes between NAC+RC and RC only groups, matched by final pathologic stages: (y)pT0N0, (y)p Tis/Ta/T1N0, (y)pT2N0, (y)pT3/T4N0, and (y)pTanyN+. RESULTS: A total of 6811 patients were included (median follow-up 45 months). Figure 1 shows the rates of each stage group stratified by NAC and Kaplan-Meier curves stratified by NAC in both the overall cohort and subcohorts. Multivariable Cox regression showed NAC+RC was associated with improved OS in the overall cohort (hazard ratio HR=0.84, 95% confidence interval CI=0.77-0.92). In the (y)pT0N0, (y)pTis/Ta/T1N0, and (y)pT2N0 subcohorts, no significant differences in OS were observed between the NAC+RC and RC only groups (HR=0.84, 95% CI=0.48-1.46, HR=0.93, 95% CI=0.63-1.37, and HR=1.12, 95% CI=0.93-1.35, respectively). However, in the (y)pT3/T4N0 and (y)pTanyN+ subcohorts, NAC+RC was associated with worse OS (HR=1.24, 95% CI=1.06-1.45 and HR=1.26, 95% CI=1.08-1.46, respectively). CONCLUSIONS: Patients with residual Tis/Ta/T1 or T2 disease after NAC+RC for clinical T2 MIBC had similar outcomes compared to their counterparts after RC only. However, patients with residual locally advanced cancer (ypT3/T4 or N+) had a worse prognosis compared to pathologic stage–matched patients undergoing RC alone. This underscores the significance of differentiating the ypTN stage from the corresponding pTN stage, particularly when designing clinical trials on adjuvant therapies. Given that adjuvant trials have been focused on patients with ypT2-4/N+ post-NAC+RC or pT3-4/N+ post-RC, future trials should consider including patients with (y)pT3-4/N+ to avoid overtreatment of (y)pT2, as ypT2and pT2 seem to have similar outcomes. Download PPT Source of Funding: NA © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1256 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Leilei Xia More articles by this author Daniel S. Roberson More articles by this author Erika L. Wood More articles by this author Anosh Dadabhoy More articles by this author Everett Knudsen More articles by this author Sofia Romano More articles by this author Thomas J. Guzzo More articles by this author Trinity J. Bivalacqua More articles by this author Siamak Daneshmand More articles by this author Expand All Advertisement PDF downloadLoading ...