Mp53-11 Neoadjuvant Chemotherapy With Radical Cystectomy in Muscle-Invasive Bladder Cancer: Evaluating the Pathological Response and Survival Outcomes in Octogenarians

You have accessJournal of UrologyBladder Cancer: Invasive V (MP53)1 May 2024MP53-11 NEOADJUVANT CHEMOTHERAPY WITH RADICAL CYSTECTOMY IN MUSCLE-INVASIVE BLADDER CANCER: EVALUATING THE PATHOLOGICAL RESPONSE AND SURVIVAL OUTCOMES IN OCTOGENARIANS Arjun Pon Avudaiappan, , Pushan Prabhakar, Daniel Ajabshir, Ahmed Eldefrawy, Jorge Caso, Rohan Garje, and Murugesan Manoharan Arjun Pon AvudaiappanArjun Pon Avudaiappan , , Pushan PrabhakarPushan Prabhakar , Daniel AjabshirDaniel Ajabshir , Ahmed EldefrawyAhmed Eldefrawy , Jorge CasoJorge Caso , Rohan GarjeRohan Garje , and Murugesan ManoharanMurugesan Manoharan View All Author Informationhttps://doi.org/10.1097/01.JU.0001008784.37684.bd.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Neoadjuvant chemotherapy (NAC) with radical cystectomy (RC) is the standard of care for muscle-invasive bladder cancer (MIBC). With improvements in healthcare, many octogenarians are undergoing RC uneventfully, but pressing concerns lie in the underutilization of NAC among older adults. Therefore, gaining an understanding on the effect of NAC among octogenarians on survival outcomes is important. Using the National Cancer Database, we analyzed the pathological response and compared overall survival outcomes between those who underwent RC with or without NAC. METHODS: We identified the octogenarians who underwent RC with or without NAC between 2004 and 2018. The NAC cohort included patients who underwent RC with NAC, and non-NAC cohort included those with or without adjuvant chemotherapy. Based on pathological response, the NAC cohort was subcategorized into responders (downstaging to ≤T2) and non-responders (no change in pathological stage or upstaging). We excluded those with comorbidity index >1, eliminating patients with potential renal impairment. After propensity-matching, with race, ethnicity, histology, comorbidity score, tumor grade, and clinical stage we compared the overall survival (OS) between NAC and non-NAC cohorts and between responders and non-responders within the NAC cohort. RESULTS: Of 33924 patients who underwent RC, 3483 were octogenarians. Among them, 572 patients underwent RC with NAC, and 2911 underwent RC without NAC. Within the NAC and non-NAC cohort, 134 (23.4%) and 129 (4.4%) experienced downstaging, while 355 (62.1%) and 2234 (76.8%) exhibited upstaging or no change (p<0.001). Among those with downstaging 60 (15.2%) patients achieved complete response (pT0N0). In matched OS analysis, NAC and non-NAC cohorts had a median OS of 51.19 months and 31.64 months, respectively (p<0.0001). Similarly, responders and non-responders to NAC had a median OS of 87.89 months and 31.57 months, respectively (p<0.0001). CONCLUSIONS: NAC with RC helps in improving OS among octogenarians. However, those who did not respond to NAC had an OS similar to the non-NAC cohort. This data helps us understand the effect of NAC in octogenarians thereby it could help in patient counseling and collaborative-decision making. Download PPT Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e867 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Arjun Pon Avudaiappan More articles by this author More articles by this author Pushan Prabhakar More articles by this author Daniel Ajabshir More articles by this author Ahmed Eldefrawy More articles by this author Jorge Caso More articles by this author Rohan Garje More articles by this author Murugesan Manoharan More articles by this author Expand All Advertisement PDF downloadLoading ...