Mp77-18 Predictors of Pelvic Recurrence After Radical Cystectomy: Identifying the Ideal Candidate for Adjuvant Radiation Clinical Trials

You have accessJournal of UrologyBladder Cancer: Invasive VI (MP77)1 May 2024MP77-18 PREDICTORS OF PELVIC RECURRENCE AFTER RADICAL CYSTECTOMY: IDENTIFYING THE IDEAL CANDIDATE FOR ADJUVANT RADIATION CLINICAL TRIALS Matthew S. Lee, Cameron J. Britton, Robert F. Tarrell, Prabin Thapa, Austin J. Martin, Bryan J. Traughber, Bradley J. Stish, Jacob J. Orme, Abhinav Khanna, Matthew K. Tollefson, Robert H. Thompson, Robert J. Karnes, Igor Frank, Stephen A. Boorjian, and Vidit Sharma Matthew S. LeeMatthew S. Lee , Cameron J. BrittonCameron J. Britton , Robert F. TarrellRobert F. Tarrell , Prabin ThapaPrabin Thapa , Austin J. MartinAustin J. Martin , Bryan J. TraughberBryan J. Traughber , Bradley J. StishBradley J. Stish , Jacob J. OrmeJacob J. Orme , Abhinav KhannaAbhinav Khanna , Matthew K. TollefsonMatthew K. Tollefson , Robert H. ThompsonRobert H. Thompson , Robert J. KarnesRobert J. Karnes , Igor FrankIgor Frank , Stephen A. BoorjianStephen A. Boorjian , and Vidit SharmaVidit Sharma View All Author Informationhttps://doi.org/10.1097/01.JU.0001009404.49693.12.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Locoregional recurrence (LR), defined as recurrence within the soft tissue of the cystectomy bed or pelvic lymph nodes, confers a poor prognosis after radical cystectomy (RC) for urothelial carcinoma. Reported LR incidences vary widely in the literature, and no risk stratification tools are commonly used to predict LR following RC. Such a tool would inform clinical trial eligibility criteria for adjuvant radiation or systemic therapy after RC. Herein, we construct a LR risk score to identify factors associated with LR following RC. METHODS: We queried our prospectively maintained RC registry to identify patients with nonmetastatic urothelial carcinoma between 1988-2022 with LR data available. Univariable and multivariable Cox regression models were used to identify factors associated with LR following cystectomy. Using the multivariable regression coefficients, a LR risk score was then created. RESULTS: In a cohort of 1256 RC patients, 18% (N=227) experienced LR with a median time to LR of 0.89 years, translating to a 2- and 5-year LR risk of 17% and 22%, respectively. On multivariable regression analysis (Table 1), increasing pT-stage (HR 1.72) and pN+ (HR 1.90) were associated with increased LR, while more lymph nodes removed were inversely associated with LR (HR 0.98, all p<0.01). A positive ureteral or urethral margin as well as a positive radial margin were both associated with increased LR, albeit with p=0.06 and p=0.07, respectively. A risk score based on regression coefficients (Table 1) stratified patients with increasing risk of 5-year LR from 2% to 52% (Figure 1). CONCLUSIONS: Approximately 20% of patients undergoing RC will experience a LR within 5 years, and the majority of these occur within 2 years. A LR risk score based on pT, pN, margin status, and number of lymph nodes removed can stratify patients with varying LR risk. This score can be used to create eligibility criteria for clinical trials of adjuvant radiation therapy after RC. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1260 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Matthew S. Lee More articles by this author Cameron J. Britton More articles by this author Robert F. Tarrell More articles by this author Prabin Thapa More articles by this author Austin J. Martin More articles by this author Bryan J. Traughber More articles by this author Bradley J. Stish More articles by this author Jacob J. Orme More articles by this author Abhinav Khanna More articles by this author Matthew K. Tollefson More articles by this author Robert H. Thompson More articles by this author Robert J. Karnes More articles by this author Igor Frank More articles by this author Stephen A. Boorjian More articles by this author Vidit Sharma More articles by this author Expand All Advertisement PDF downloadLoading ...