Mp71-08 High Grade T1 Urothelial Cancer With Lymphovascular Invasion: Non-Muscle Invasive Bladder Cancer or Not?

You have accessJournal of UrologyBladder Cancer: Non-invasive IV (MP71)1 May 2024MP71-08 HIGH GRADE T1 UROTHELIAL CANCER WITH LYMPHOVASCULAR INVASION: NON-MUSCLE INVASIVE BLADDER CANCER OR NOT? 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.0001009548.76580.ba.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The understaging of high-grade T1 (cT1HG) urothelial cancer is common. Previous studies have indicated the association between lymphovascular invasion (LVI) and poor prognosis. However, outcomes between cT1HG urothelial cancer with LVI and organ confined (cT2) muscle invasive bladder cancer (cT2MIBC) remain inadequately explored. We aimed to investigate whether cT1HG with LVI presents worse outcomes compared to cT2MIBC. METHODS: We selected patients with cT1-2N0M0 urothelial cancer who underwent RC and lymph node dissection (LND) without neoadjuvant chemotherapy (NAC) from the National Cancer Database (NCDB) (2010-2018). Patients were classified into 4 groups based on clinical stage and LVI status (cT1 without LVI, cT1 with LVI, cT2 without LVI, and cT2 with LVI). The primary outcome was upstaging to pT3-4/pN+ at RC. The secondary outcome was overall survival (OS). Outcomes were compared among 4 groups, followed by comparison between the cT1 with LVI group and the cT2 overall cohort. RESULTS: A total of 8311 patients (cT1=2296, cT2=6015) were included. The final pathologic stage distribution is shown in the Table 1. Among patients with cT1 with LVI, 84% had pT2-4 or pN+ disease at RC. Compared to cT2 without LVI, the rate of upstaging to pT3-4/pN+ (69% vs 44%, p<0.001) and rate of pN+ disease (45% vs 12%, p<0.001) were significantly higher in the cT1 with LVI group. Compared to cT2 overall cohort, the rate of upstaging to pT3-4/pN+ (69% vs 62%, p=0.002) and rate of pN+ disease (45% vs 30%, p<0.001) were also significantly higher in the cT1 with LVI group. OS stratified by groups is shown in the Table 1/Figure. Multivariable Cox regression showed that cT1 with LVI, compared to cT2 without LVI, was associated with significantly worse OS (hazard ratio HR=1.63, 95% confidence interval CI=1.45-1.83). Likewise, compared to the cT2 overall cohort, cT1 with LVI was associated with significantly worse OS (HR=1.15, 95%CI=1.03-1.28). CONCLUSIONS: It is imperative that LVI is reported in the transurethral resection of bladder tumor pathological reports, considering its significant impact on understaging and prognosis. cT1HG with LVI is an extremely aggressive entity and presents worse outcomes than cT2 MIBC without LVI. Future studies and clinical trials should explore the possibility of NAC+RC as the standard of care. Download PPT Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1163 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 ...