Mp22-02 Pathologic and Survival Outcomes Following Radical Cystectomy for “Progressive” and “De Novo” Muscle-Invasive Bladder Cancer: A Meta-Analysis Stratified by Neoadjuvant Chemotherapy Status

You have accessJournal of UrologyBladder Cancer: Invasive II (MP22)1 May 2024MP22-02 PATHOLOGIC AND SURVIVAL OUTCOMES FOLLOWING RADICAL CYSTECTOMY FOR "PROGRESSIVE" AND "DE NOVO" MUSCLE-INVASIVE BLADDER CANCER: A META-ANALYSIS STRATIFIED BY NEOADJUVANT CHEMOTHERAPY STATUS Leilei Xia, Anosh Dadabhoy, Erika L. Wood, Sejal V. Mehta, Daniel S. Roberson, Thomas J. Guzzo, Trinity J. Bivalacqua, and Siamak Daneshmand Leilei XiaLeilei Xia , Anosh DadabhoyAnosh Dadabhoy , Erika L. WoodErika L. Wood , Sejal V. MehtaSejal V. Mehta , Daniel S. RobersonDaniel S. Roberson , Thomas J. GuzzoThomas J. Guzzo , Trinity J. BivalacquaTrinity J. Bivalacqua , and Siamak DaneshmandSiamak Daneshmand View All Author Informationhttps://doi.org/10.1097/01.JU.0001008608.50694.4b.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Muscle-invasive bladder cancer (MIBC) can present as de novo MIBC (dnMIBC) or progressive MIBC (pgMIBC), the latter occurring in patients with a history of non-muscle-invasive bladder cancer (NMIBC). Retrospective cohort studies have reported varied outcomes following RC for pgMIBC versus dnMIBC. Here we aim to pool survival and pathologic outcomes in patients with pgMIBC and dnMIBC following radical cystectomy (RC), with an investigation of the impact of neoadjuvant chemotherapy (NAC). METHODS: A literature search was conducted on PubMed and EMBASE databases to identify studies comparing pgMIBC to dnMIBC. Survival outcomes, including cancer-specific survival (CSS), overall survival (OS), and recurrence-free survival (RFS), and pathologic outcomes following surgery (rates of ≤pT1, pT0, pT3/T4, and pN+) were compared between pgMIBC and dnMIBC. RESULTS: The analysis included 19 cohorts from 16 studies, categorized into three groups based on NAC status: 1. patients who underwent RC following completion of NAC (RC+NAC only group); 2. patients who underwent RC, with or without NAC (RC +/- NAC group); 3. patients who only underwent RC without NAC (RC only group). Compared to dnMIBC, pgMIBC demonstrated worse outcomes for CSS, OS, and RFS (see Table 1). In the RC+NAC only group (3 cohorts), the hazard ratio (HR) for CSS was 1.52 (95% confidence interval CI = 1.05-2.2), the HR for OS was 1.46 (95%CI = 1.05-2.02). Similarly, in the RC +/- NAC group (6 cohorts for CSS and 3 cohorts for OS), the HR for CSS was 1.27 (95%CI = 1.05-1.55), and the HR for OS was 1.27 (95%CI = 1.08-1.51). There were no significant differences observed in pathologic outcomes, including rates of ≤pT1, pT0, and pT3/T4 disease, across all subgroups. However, pgMIBC was associated with a higher risk of nodal metastatic (pN+) disease in the RC+NAC only group (4 cohorts, relative risk RR = 1.43, 95%CI = 1.12-1.84). CONCLUSIONS: The findings highlight the potentially worse prognosis in patients with pgMIBC compared to dnMIBC, even with the modern use of NAC. The study emphasizes the importance of careful patient counseling, further classification of patients for treatment selection, and the consideration of additional or innovative systemic therapies for pgMIBC. Download PPT Source of Funding: NA © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e340 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Leilei Xia More articles by this author Anosh Dadabhoy More articles by this author Erika L. Wood More articles by this author Sejal V. Mehta More articles by this author Daniel S. Roberson 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 ...