Page 1 - CUA2018 Abstracts - Oncology-Bladder

2018 CUA AbstrACts

Poster Session 5: Other Oncology I

June 25, 2018; 0800–0930

MP–5.1 Methods: This observational, retrospective study enrolled 231 patients who
Determinants of postoperative hospital stays in a cohort of bladder underwent TURBT for non–muscle–invasive bladder cancer (NMIBC) at a
cancer patients undergoing radical cystectomy in Quebec, 2000– single centre between 1996 and 2014. Chi–square tests, Kaplan–Meier
2013 estimates, logistic regression, and Cox proportional hazard models were
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Michel Wissing , Fabiano Santos , Ahmed Zakaria , Ana O’Flaherty , used to explore the association between anesthetic type and each of cancer
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Wassim (Wes) Kassouf , Simon Tanguay , Armen Aprikian 1 recurrence, cancer progression, and mortality.
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1 Urology, McGill University Health Centre, Montreal, QC, Canada; Results: In univariable analysis, patients under SA (n=135) had a longer
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2 Oncology, McGill University, Montreal, QC, Canada; Division of median time to recurrence (42.1 vs. 17.2 months; p=0.014) compared to
Technology and Innovation, International Development Research Centre, those who had GA (n=96) (Fig. 1; available at https://cua.guide/). In mul-
Ottawa, ON, Canada tivariable analyses, incorporating key a priori variables, including cancer
Introduction: Radical cystectomy (RC) has been the standard of care for risk (amalgam of stage, grade, presence of carcinoma in situ, number and
muscle–invasive bladder cancer (BCa) patients for decades. Prolonged size of tumours), perioperative chemotherapy, and adjuvant immunotherapy,
hospital stays occur frequently after RC, increasing costs and decreasing patients under GA had a higher incidence of recurrence (odds ratio 2.062;
quality of life. We evaluated determinants of postoperative hospital stays 95% confidence interval [CI] 1.14–3.74; p=0.017) and earlier time to recur-
in BCa patients. rence (hazard ratio 1.57; 95% CI 1.13–2.1; p=0.008) compared to patients
Methods: We used data from two cohorts of RC–treated BCa patients in under SA. Anesthetic type was not associated with cancer progression or
Quebec, collected from provincial health administrative databases (cohort overall mortality.
A: January 2000 to September 2009; cohort B: October 2009 to December Conclusions: Patients receiving a GA had higher incidence of recurrence
2013). Outcomes were time to hospital discharge after RC, number of days and earlier time to recurrence following TURBT for NMIBC compared to
in hospital within 30/90/365 days after RC, and hospital readmission rates. patients undergoing SA. These findings should prompt large–scale, prospec-
Covariates studied were age, sex, hospital size (by number of beds), surgeons’ tive studies to further delineate this association.
and hospitals’ annual RC load, and distance to the hospital. Linear regres-
sion and Cox proportional hazards models were used for statistical analyses. MP–5.3
Results: The cohort included 3975 BCa patients, most were aged 60–80 Trends and disparities in the use of neoadjuvant chemotherapy
(69.0%) and male (75.4%). On average, patients spent 16 days in the hos- for muscle–invasive urothelial carcinoma
pital in the 90 days following surgery; this was least in patients who were Jon Duplisea , Ross Mason , Chad Reichard , Roger Li , Stephen Boorjian ,
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younger (–1.3 days per five–year decrement), male (–1.9 days), or treated Colin Dinney 1
in centres with high annual RC volumes (–1.0 days per 10 RC/year incre- 1 Urology, University of Texas MD Anderson Cancer Center, Houston, TX,
ment). These determinants, and more recent surgery, predicted the time in United States; Urology, Mayo Clinic, Rochester, MN, United States
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hospital in the 30/365 days after RC too. Adjusting for age and sex, patients Introduction: Neoadjuvant chemotherapy (NAC) prior to radical or partial
treated after September 2009 were discharged more quickly post–RC (haz- cystectomy is considered the standard of care for eligible patients with mus-
ard ratio [HR] 1.10; p=0.005), while readmission rates were similar (HR cle–invasive urothelial carcinoma (MIBC). Despite guideline recommenda-
1.03; p=0.467). One cause for this improvement was an increased number tions, widespread adoption of NAC has historically been low, although prior
of RCs in centres with high annual RC volumes (age– and sex–adjusted HR studies have suggested that use is increasing. In this contemporary study,
for discharge 1.04; p<0.001; HR for readmission 0.99; p=0.476). Distance we examine whether the use of NAC has continued to increase with time
to the hospital did not predict hospital stay duration (p≥0.12). and we explore factors associated with the receipt of NAC.
Conclusions: Hospital stay durations after RC have decreased over time, Methods: We identified all patients included in the National Cancer
while readmission rates remained stable. Limiting RCs to specialized centres Database who underwent radical or partial cystectomy for cT2–CT4N0M0
may further decrease postoperative hospital stays. urothelial carcinoma from 2006–2014. The proportion of patients receiv-
ing NAC during each year was examined. Logistic regression models were
MP–5.2 used to evaluate clinical and socioeconomic factors associated with the
Spinal anesthesia is associated with lower recurrence rates after receipt of NAC.
resection of non–muscle–invasive bladder cancer Results: There were 18 188 patients identified who underwent RC or PC
Gregory Hosier , Yuri Koumpan , Melanie Jaeger , Glenio Mizubuti , Rob for MIBC. Overall, 3940 (21.7%) received NAC. There was a significant
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Tanzola , Kunal Jain , Wilma Hopman , Robert Siemens 1 increase in the use of NAC over time, from 9.7% in 2006 to 32.2% in
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1 Urology, Queen’s University, Kingston, ON, Canada; Anesthesiology, 2014 (Fig. 1; available at https://cua.guide/). Factors associated with lower
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Queen’s University, Kingston, ON, Canada; Kingston General Hospital use of NAC include older age, increased number of comorbidities, lower
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Research Institute and Department of Public Health Sciences, Queen’s cT stage, lower hospital RC volume, treatment at a non–academic facility,
University, Kingston, ON, Canada lower patient income, and receipt of partial cystectomy (all p<0.01). Neither
Introduction: There is increasing evidence that use of spinal anesthetic (SA) patient sex nor race were associated with the receipt of NAC.
compared to general anesthetic (GA) may lead to improved oncological Conclusions: Use of NAC for patients with MIBC has increased significantly
outcomes by minimizing use of volatile anesthetics and opioids, which are over time. However, significant disparities exist in the receipt of NAC and
associated with perioperative immunosuppression and increased tumour future efforts aimed at mitigating these disparities are warranted. Improved
seeding. The aim of our study was to determine if anesthetic type would risk stratification to identify high–risk individuals is one strategy that might
influence our primary outcome of cancer recurrence following transurethral increase the use of NAC.
resection of bladder tumours (TURBT).
CUAJ • June 2018 • Volume 12(6Suppl2) S89
© 2018 Canadian Urological Association