Mp71-04 Intravesical Instillations in Octagenerian High Grade, Non Muscle-Invasive Bladder Cancer Patients: Could They Offer a Real Survival Advantage?

You have accessJournal of UrologyBladder Cancer: Non-invasive IV (MP71)1 May 2024MP71-04 INTRAVESICAL INSTILLATIONS IN OCTAGENERIAN HIGH GRADE, NON MUSCLE-INVASIVE BLADDER CANCER PATIENTS: COULD THEY OFFER A REAL SURVIVAL ADVANTAGE? Giovanni Guano, Francesco Chierigo, Silvia Rebuffo, Stefano Parodi, Stefano Tappero, Francesca Ambrosini, Francesco Vecco, Calogero Paola, Giorgia Granelli, Enrico Vecchio, Lorenzo Luigi Biagio Lo Monaco, Benedetta Col, Giulia Ragno, Guglielmo Mantica, Carlo Terrone, and Marco Borghesi Giovanni GuanoGiovanni Guano , Francesco ChierigoFrancesco Chierigo , Silvia RebuffoSilvia Rebuffo , Stefano ParodiStefano Parodi , Stefano TapperoStefano Tappero , Francesca AmbrosiniFrancesca Ambrosini , Francesco VeccoFrancesco Vecco , Calogero PaolaCalogero Paola , Giorgia GranelliGiorgia Granelli , Enrico VecchioEnrico Vecchio , Lorenzo Luigi Biagio Lo MonacoLorenzo Luigi Biagio Lo Monaco , Benedetta ColBenedetta Col , Giulia RagnoGiulia Ragno , Guglielmo ManticaGuglielmo Mantica , Carlo TerroneCarlo Terrone , and Marco BorghesiMarco Borghesi View All Author Informationhttps://doi.org/10.1097/01.JU.0001009548.76580.ba.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To analyze survival outcomes of octogenarian patients (pts) with high grade non-muscle-invasive bladder cancer (HG-NMIBC) treated either with intravesical therapy or surveillance. METHODS: We retrospectively analyzed pts aged ≥80 treated with transurethral resection of the bladder (TURB) and diagnosed with HG-NMIBC from a single academic institution from 2016 to 2020. Pts were treated with either intravesical instillation or surveillance. Descriptive statistics analyzed differences in perioperative characteristics. Smoothed Poisson regression plots depicted cancer specific mortality (CSM) and other-cause mortality (OCM). Kaplan-Meier plot depicted recurrence free survival according to treatment. We relied on cumulative incidence plots and univariable competing-risks regression models to analyze differences in CSM and OCM among patients managed by surveillance vs intravesical instillations either mitomycin C (MMC) or bacillus Calmette-Guerin (BCG). RESULTS: We collected 121 pts with a median age of 84 (IQR 81-87), of which 15 (12%) were females. Overall, 74 (61%) of pts had a first diagnosis of BCa and 59 (49%) had multifocal disease. At presentation, 33 (27%) had a tumor size ≥3cm. Intermediate, high and very-high EAU NMIBC risk was present in respectively 17 (14%), 82 (68%), and 22 (18%) pts. After diagnosis of NMIBC, 80 (66%) pts were surveilled, 24 (20%) were treated with BCG, 17 (14%) with MMC. Median follow-up was 60 months. Overall, 5-year CSM rate was 9% and 5-year OCM rate was 50%. Overall, 44 (36%) pts recurred within 10 months. Recurrence rate for pts under surveillance was 38% (30 pts) vs. 38% (9 pts) for BCG vs. 29% (5 pts). Cumulative incidence plots and univariable competing-risks regression models revealed no difference in 5-year CSM rates in surveillance vs intravesical instillations (9.6 vs 10%, HR 1.09, 95% CI (0.33 - 3.65), p=0.9), as well as in OCM rates 57 vs 35%, HR 0.66, 95% CI (0.39 - 0.12), p=0.1. CONCLUSIONS: Mortality in octogenarian pts with HG-NMIBC is mostly attributable to OCM. Our study suggests that, in those pts, intravesical instillations do not seem to provide an oncological survival benefit. Induction and maintenance with BCG and Mitomycin C should therefore be carefully considered as a treatment in elderly pts. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1161 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Giovanni Guano More articles by this author Francesco Chierigo More articles by this author Silvia Rebuffo More articles by this author Stefano Parodi More articles by this author Stefano Tappero More articles by this author Francesca Ambrosini More articles by this author Francesco Vecco More articles by this author Calogero Paola More articles by this author Giorgia Granelli More articles by this author Enrico Vecchio More articles by this author Lorenzo Luigi Biagio Lo Monaco More articles by this author Benedetta Col More articles by this author Giulia Ragno More articles by this author Guglielmo Mantica More articles by this author Carlo Terrone More articles by this author Marco Borghesi More articles by this author Expand All Advertisement PDF downloadLoading ...