Mp15-07 Molecular Subtyping for Predicting Non-Organ Confined Disease and Survival Outcomes After Radical Cystectomy in Clinical High-Grade T1 and T2 Bladder Cancer Patients

You have accessJournal of UrologyBladder Cancer: Basic Research & Pathophysiology I (MP15)1 May 2024MP15-07 MOLECULAR SUBTYPING FOR PREDICTING NON-ORGAN CONFINED DISEASE AND SURVIVAL OUTCOMES AFTER RADICAL CYSTECTOMY IN CLINICAL HIGH-GRADE T1 AND T2 BLADDER CANCER PATIENTS Yair Lotan, Joep J. de Jong, James Proudfoot, Sia Daneshmand, Robert Svatek, Vikram Narayan, Shreyas Joshi, Roger Li, Brant Inman, Jonathan Wright, Paras Shah, and Ewan Gibb Yair LotanYair Lotan , Joep J. de JongJoep J. de Jong , James ProudfootJames Proudfoot , Sia DaneshmandSia Daneshmand , Robert SvatekRobert Svatek , Vikram NarayanVikram Narayan , Shreyas JoshiShreyas Joshi , Roger LiRoger Li , Brant InmanBrant Inman , Jonathan WrightJonathan Wright , Paras ShahParas Shah , and Ewan GibbEwan Gibb View All Author Informationhttps://doi.org/10.1097/01.JU.0001009500.87761.bf.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Accurate clinical staging bladder cancer represents a significant clinical challenge as many patients are upstaged to non-organ confined (NOC) disease (pT3+ and/or N+) at radical cystectomy (RC). A prior multicenter trial found that molecular subtyping could improve clinical staging and for predicting patient outcomes. This study is an independent multicenter evaluation of the Decipher Bladder Genomic Subtyping Classifier (GSC) for predicting upstaging and outcomes on a cohort of patients with clinical T1 and T2 bladder cancer who underwent radical cystectomy without neoadjuvant therapy. METHODS: Microarray data was analyzed from bladder tumor specimens resected transurethrally from a cohort of patients with high grade cT1-T2 N0M0 UC who subsequently underwent RC without NAC (n=200). Molecular subtypes were determined using the Decipher Bladder GSC Seiler 2017, Batista da Costa 2019]. The primary endpoint was pathological upstaging to non-organ confined disease (pT3+ and/or N+), while the secondary endpoints were cancer specific mortality (CSM) and overall survival (OS). RESULTS: In the patient cohort, 108 and 92 patients were clinical T1 and T2, respectively. The overall rate of upstaging to NOC was 31% for cT1 and 69% for cT2 patients. Molecular subtyping identified 117 luminal tumors, 16 infiltrated luminal, 48 basal, 15 claudin-low tumors and 4 neuroendocrine-like (NE-like). Non-luminal tumors (infiltrated luminal, basal, claudin-low, NE-like), were upstaged to NOC disease at a rate of 42.2%, compared to 30.8% for luminal tumors (p=0.1). For cT1 luminal tumors, the rates of upstaging were 18% compared to 27% for cT1 non-luminal tumors. Within cT2 tumors, upstaging rates were similar at 41% and 47% for luminal and non-luminal tumors, respectively. Kaplan-Meier analysis revealed significantly improved survival outcomes (both OS and CSM) for patients with luminal tumors versus non-luminal tumor patients within the cT2 patient subgroup. CONCLUSIONS: Molecular subtyping suggests that luminal tumors harbor a less aggressive disease state reflected by lower rates of upstaging compared to non-luminal tumors. Critically, luminal tumors in the cT2 population showed a significantly improved outcomes compared to non-luminal tumors, even in the absence of systemic chemotherapy. Source of Funding: Veracyte © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e231 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Yair Lotan More articles by this author Joep J. de Jong More articles by this author James Proudfoot More articles by this author Sia Daneshmand More articles by this author Robert Svatek More articles by this author Vikram Narayan More articles by this author Shreyas Joshi More articles by this author Roger Li More articles by this author Brant Inman More articles by this author Jonathan Wright More articles by this author Paras Shah More articles by this author Ewan Gibb More articles by this author Expand All Advertisement PDF downloadLoading ...