Page 2 - CUA2018 Abstracts - Oncology-Bladder

Poster session 5: Other Oncology I

MP–5.4 (n=3, 23.1%) (p=0.4630). The majority (n=11, 84.6%) of them were cN0
Between–surgeon variation in outcomes of radical cystectomy and 15.4% cN+ (n=2) (p=0.0063). Overall, 41.5% (n=17) patients had
for bladder cancer in a universal healthcare system recurrent disease. CSM and OM was 26.8% (n=11), with a median DFS
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Jan Rudzinski , Niels Jacobsen , Sunita Ghosh , Benjamin Beech , Ryan of 7.6 months and a median 10.5–month survival. Of the 30 survivors,
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McLarty , Steven Tong , Adrian Fairey 1 20% (n=6) live with recurrent disease (DFS 12.9 months).
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1 Urology, University of Alberta, Edmonton, AB, Canada; Medical Conclusions: We report a 19.5% CR rate and a 31.7% PR rate in neo-
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Oncology, University of Alberta, Edmonton, AB, Canada adjuvant MVAC for MIBC. Moreover, we report an increased PR rate in
Introduction: Radical cystectomy for bladder cancer is a complex surgi- patients with preoperative cN0. Our data support growing evidence of
cal oncology procedure. It is plausible that outcomes may vary among lower CR rates to neoadjuvant MVAC observed in retrospective studies
individual surgeons. We determined whether between–surgeon varia- compared to previous randomized controlled trials.
tion, known as heterogeneity, exists for urologic surgeons practicing at a References:
Canadian academic centre in a universal healthcare system. 1. Grossman HB, Natale RB, Tangen CM, et al. Neoadjuvant chemo-
Methods: A retrospective analysis of data from the University of Alberta therapy plus cystectomy compared with cystectomy alone for locally
(UA) Radical Cystectomy Database was performed. Between September advanced bladder cancer. N Engl J Med 2003;349:859–66. https://
1994 and September 2017, 1031 consecutive patients underwent cura- doi.org/10.1056/NEJMoa022148
tive–intent radical cystectomy for histologically proven urothelial carci- 2. International collaboration of trialists. Neoadjuvant cisplatin, metho-
noma of the bladder (cTanyN1–3M0) by one of 10 urologic surgeons. trexate, and vinblastine chemotherapy for muscle–invasive bladder
Outcomes were 90–day mortality rate, positive surgical margin (R1) resec- cancer: A randomized controlled trial. Lancet 1999;354:533–40.
tion rate, total number of lymph nodes evaluated, and 90–day blood https://doi.org/10.1016/S0140–6736(99)02292–8
product transfusion rate. Multivariable random effects models were used 3. Sagaster P, Flamm J, Flamm M, et al. Neoadjuvant chemo-
to evaluate heterogeneity in outcomes after adjustment for case mix. therapy (MVAC) in locally invasive bladder cancer. Eur J Cancer
Statistical tests were two–sided (p≤0.05). 1996;32A:1320–4. Lee FC, Harris W, Cheng HH, et al. Pathologic
Results: Data were evaluable for 1031 patients. There was significant response rates of gemcitabine/cisplatin vs. methotrexate/vinblastine/
between–surgeon variation in 90–day mortality rate (p=0.001), R1 resec- adriamycin/cisplatin neoadjuvant chemotherapy for muscle–invasive
tion rate (p=0.018), total number of lymph nodes evaluated (p<0.001), urothelial bladder cancer. Adv Urol 2013;317190.
and 90–day blood product transfusion rate (p<0.001). Four surgeons 4. Lee FC, Harris W, Cheng HH, et al. Pathologic response rates of gem-
had adjusted 90–day mortality rates ≤3%, whereas eight surgeons had citabine/cisplatin vs. methotrexate/vinblastine/adriamycin/cisplatin
adjusted 90–day mortality rates ≥8%. Two surgeons had adjusted R1 neoadjuvant chemotherapy for muscle–invasive urothelial bladder
resection rates ≤6%, whereas four surgeons had adjusted R1 resection cancer. Adv Urol 2013;317190.
rates ≥10%. Two surgeons had >18 lymph–nodes evaluated, whereas 5. Sternberg CN, de Mulder PH, Schornagel JH, et al. Randomized
four surgeons had <10 lymph–nodes evaluated. Two surgeons had blood phase 3 trial of high–dose–intensity methotrexate, vinblastine,
product transfusion rate of <20%, whereas three surgeons had blood doxorubicin, and cisplatin (MVAC) chemotherapy and recombi-
product transfusion rate of >50%. nant human granulocyte colony–stimulating factor vs. classic MVAC
Conclusions: A patient’s likelihood of achieving optimal clinical outcomes in advanced urothelial tract tumours: European Organization for
differs depending on which urologic surgeon performs his/her radical Research and Treatment of Cancer Protocol no. 30924. J Clin Oncol
cystectomy. Research examining the mechanism(s) underlying surgical 2001;19:2638–46. https://doi.org/10.1200/JCO.2001.19.10.2638
heterogeneity in outcomes of radical cystectomy is needed. 6. Zargar H, Espiritu PN, Fairey AS, et al. Multicentre assessment of
neoadjuvant chemotherapy for muscle–invasive bladder cancer. Eur
Urol 2015;67:241–9. https://doi.org/10.1016/j.eururo.2014.09.007
MP–5.5 7. Fairey AS, Daneshmand S, Quinn D, et al. Neoadjuvant chemo-
Pathological response rates and survival in patients with radical therapy with gemcitabine/cisplatin vs. methotrexate/vinblastine/
cystectomy and methotrexate/vinblastine/doxorubicin/cisplatin doxorubicin/cisplatin for muscle–invasive urothelial carcinoma of
(MVAC) neoadjuvant chemotherapy for muscle–invasive bladder the bladder: A retrospective analysis from the University of Southern
cancer California. Urol Oncol 2013;31:1737–43. https://doi.org/10.1016/j.
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Ioana Fugaru , Elizabeth Naud , Louis Lacombe , Yves Fradet , Vincent urolonc.2012.07.005
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Fradet , Paul Toren , Michele Lodde 2
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1 Faculté de Médecine, Université Laval, Quebec City, QC, Canada;
2 Centre Hospitalier Universitaire de Québec, Hôpital de l’Hôtel–Dieu MP–5.6
de Québec, Université Laval, Quebec City, QC, Canada A population–based study demonstrating passive centralization
Introduction: Randomized controlled trials that supported methotrexate/ of radical cystectomy: Potential associations with other quality
vinblastine/doxorubicin/cisplatin (MVAC) as a neoadjuvant chemotherapy indicators
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regimen in muscle–invasive bladder cancer (MIBC) report a complete Kashif Visram , Christopher Booth , Xuejiao Wei , Robert Siemens 1,2
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response (CR) rate as high as 38% at radical cystectomy (RC). In the 1 Division of Urology, Queen’s University, Kingston, ON, Canada;
past decade, different studies have reported lower CR rates in the MVAC 2 Division of Cancer Care and Epidemiology, Queen’s University, Kingston,
regimen in real–life practice. 5–7 The purpose of this study was to deter- ON, Canada
mine CR and partial response (PR) rates, as well as survival outcomes, in Introduction: Consolidating complex surgical procedures to higher–vol-
patients treated with neoadjuvant MVAC at our centre. ume centres has been demonstrated to lead to enhanced processes of care
Methods: We retrospectively reviewed 41 patients with urothelial MIBC and patient outcomes. In England, centralization of radical cystectomies
who underwent neoadjuvant MVAC and RC at the Hôtel–Dieu de Québec (RC) was mandated in 2003, with recent documentation of improved
Hospital between 2012 and 2017. Median age was 66.2 years and 30 early outcomes. Although not mandated in Canada, we hypothesize that
patients were male. Twenty–three patients had cT2, 12 had cT3, and centralization of RC has occurred passively. In this study, we explore
six had cT4 disease, while 21 had clinically negative lymph nodes (cN0) passive centralization of care and whether it is associated with other
and 20 had cN+. Primary outcomes were rates of pathological CR, defined process–related quality indicators and outcomes.
as pT0N0M0, and PR, defined as ≤pT1N0 (pT1/Tis/Ta/ T0). Secondary Methods: Electronic records of treatment were linked to the population–
outcomes were disease–free survival (DFS), cancer–specific mortality based Ontario Cancer Registry to identify all patients who underwent
(CSM), and overall mortality (OM). RC for bladder cancer from 1994–2013. Patients were classified in two
Results: Median followup time was 10.5 months. CR was 19.5% (n=8) temporal cohorts: a historic cohort with RC in 1994–2008, and a more
and PR was 31.7% (n=13). Most (n=7, 87.5%) patients with CR were cT2. contemporary cohort with RC in 2009–2013. The primary objective was
Patients with PR were mostly cT2, (n=10, 76.9%) and less frequently cT3 to describe mean annual surgeon and hospital RC volume. Secondary
S90 CUAJ • June 2018 • Volume 12(6Suppl2)