Page 5 - CUA2018 Abstracts - Oncology-Bladder

Poster session 5: Other Oncology I

Conclusions: Our multicentre study found that diabetes was not signifi- Methods: The International Patient Decision Aids Standards (IPDAS) and
cantly associated with cancer–specific or overall survival in kidney cancer the Ottawa Decision Support Framework were used to guide the sys-
patients undergoing nephrectomy. These findings do not support altering tematic development of the decision aid. A review of the literature was
treatment approach or followup strategies in diabetic patients. performed for urinary diversion options following radical cystectomy. The
content of the decision aid was agreed upon by content and methodologi-
MP–5.12 cal experts using an iterative feedback process. A survey was created to
assess the content and clarity of the patient decision aid. The primary
Surveillance guidelines based on recurrence patterns for upper outcome was patient and clinician acceptability of the decision aid.
tract urothelial carcinoma Results: An evidence–based patient decision aid presented evidence
Jennifer Locke , Reza Hamidizadeh , Wassim (Wes) Kassouf , Ricardo on options, including probabilities of benefits and harms. Ileal conduit
2
1
1
Rendon , David Bell , Jonathan Izawa , Joseph Chin , Anil Kapoor , and orthotopic neobladder were the urinary diversion options that were
4
5
3
4
3
Bobby Shayegan , Jean–Baptiste Lattouf , Fred Saad , Louis Lacombe , most cited. The included outcomes were: urinary retention, daytime and
6
7
6
5
Yves Fradet , Adrian Fairey , Niels Jacobsen , Darrel Drachenberg , Ilias nighttime incontinence, stoma management, and stoma complications.
9
8
8
7
Cagiannos , Alan So , Peter Black 1 Simple language and pictures were used to ensure the decision aid was
1
10
1 Urologic Sciences, University of British Columbia, Vancouver, BC, user–friendly for a wide range of patients. A validated screening instru-
Canada; Urology, McGill University, Montreal, QC, Canada; Urology, ment was included to assess patients’ decisional conflict. Knowledge
2
3
Dalhousie University, Halifax, NS, Canada; Urology, University of questions were used to verify patients’ understanding. The decision aid
4
Western Ontario, London, ON, Canada; Urology, McMaster University, met all IPDAS criteria to be defined as a decision aid, five of six criteria
5
Hamilton, ON, Canada; Urology, University of Montreal, Montreal, QC, for certification, and 17 of 23 quality criteria.
6
Canada; Urology, Université Laval, Quebec City, QC, Canada; Urology, Conclusions: A patient decision aid was created to facilitate shared–deci-
7
8
University of Alberta, Edmonton, AB, Canada; Urology, University of sion making for patients undergoing urinary diversion following radical
9
Manitoba, Winnepeg, MB, Canada; Urology, University of Ottawa, cystectomy. The effectiveness of our decision aid is currently being evalu-
10
Ottawa, ON, Canada ated prospectively.
Introduction: Evidence to guide postoperative surveillance of upper tract
urothelial carcinoma (UTUC) is lacking. Here, we developed a postradical
nephroureterectomy (RNU) surveillance protocol based on recurrence UP–5.2
patterns in a large, multi–institutional cohort of patients. Genomic characterization of paired cystectomy and lymph node
Methods: Clinical and pathological data were collected retrospectively metastases in bladder urothelial carcinoma
from 1029 patients undergoing RNU over a 15–year period (1994–2009) Victor McPherson , Bernard Bochner , Shawn Dason , Priscilla Baez ,
1
1
1
1
at 10 Canadian academic institutions. A multivariable model was used to Eugene Pietzak , Eugene Cha , Christine Iacobuzio–Donahue , Timothy
1
1
1
identify prognostic clinico–pathological factors, which were then used to Donahue 1
define risk categories. Risk–based surveillance guidelines were proposed 1 Surgery; Urology, Memorial Sloan Kettering Cancer Center, New York,
based on actual recurrence patterns. NY, United States
Results: Overall, 555 (49.9%) patients developed recurrence, including Study Groups: Funding: Pin Down Bladder Cancer.
289 (25.9%) urothelial recurrences and 266 (23.9%) loco–regional and Introduction: Multicentre sequencing initiatives show a high proportion
distant recurrences. On multivariable analysis, age, female gender, tumour of high–grade urothelial cancers (HGUCs) harbour genetic alterations.
multifocality, positive surgical margins, and presence of lymphovascular To identify mechanisms of nodal metastasis, we characterized the altera-
invasion (LVI) were significant predictors of urothelial recurrence while tions within paired radical cystectomy (RC) and concurrent lymph node
female gender, ≥pT2, pN+, high tumour grade, tumour multifocality, and (LN) metastases.
LVI were significant predictors of loco–regional and distant recurrence. Methods: Twenty–five HGUCs from 11 patients were sequenced on a
Three risk groups were identified: 1) low–risk patients with pTa–T1, pN0 IRB–approved protocol using a 230–468 cancer–associated gene panel.
disease and no adverse histological features (high tumour grade, LVI, A pathologist reviewed H&E slides to confirm grade, stage, and histology.
tumour multifocality); 2) intermediate–risk patients with pTa–T1, pN0 Genetic alterations were identified and predicted or established onco-
disease with one or more of the adverse histological features; and 3) high– genic driver alterations were identified by the OncoKB database.
risk patients with either a ≥pT2 tumour and/or nodal involvement. Low–, Results: Paired RC and LN metastases were sequenced from nine patients,
intermediate–, and high–risk patients had a five–year survival rate of including three with paired discrete LNs. Two patients who were pT0 at
0.59, 0.47, and 0.34, respectively. The risks of loco–regional and distant RC had paired LNs sequenced. Median age was 67.3 (range 45.0–86.3),
recurrences and time to death (both p<0.0001) were significantly differ- tumours were HGUC, and pathological stage at RC was pT0–T4, N1–3.
ent between the low–, intermediate–, and high–risk patients. Using this An average 16.1 alterations were identified per patient; of these, 6.4 were
data, we propose a surveillance protocol outlined in Table 1 (available predicted to be oncogenic across 37 discrete genes within the cohort.
at https://cua.guide/). These include similar rates in genes identified by the TCGA cohort; TP53
Conclusions: Based on recurrence patterns in each risk group, we have pro- (12/25, 48% of samples), FGFR3 (5/25, 20%), PIK3CA (4/25, 16%), and
posed an evidence–based, risk–adapted post–RNU surveillance protocol. RB1 (4/25, 16%). There was low concordance between the alterations in
the RC samples and paired LN metastases (50.7% overall, 59.5% onco-
UP–5.1 genic drivers), with an overall average of 10.1 total and 4.2 oncogenic
driver alterations in the cystectomies and 13.6 total and 5.7 drivers in the
Development of a patient decision aid for urinary diversion nodal metastases. Conversely, the genetic alterations were highly con-
following radical cystectomy cordant between paired nodal samples in the five patients with multiple
Preveshen Moodley , Luke Lavallee , Dawn Stacey , Kristen McAlpine , nodes sequenced (89.5% overall, 92.7% oncogenic drivers) .
1
2,3
3
2
Rodney Breau 2,3 Conclusions: LN metastases harbour discrete genetic alterations when
1 Division of Urology, Health Sciences North, Sudbury, ON, Canada;
2 Division of Urology, University of Ottawa, Ottawa, ON, Canada; The compared to the primary tumour in patients undergoing RC for HGUC.
3
Conversely, alterations are highly concordant between discrete nodal
Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, metastases within the same anatomical region, indicating that a subset
Canada of cell clones migrate from the primary tumour to form LN metastases.
Introduction: Patient decision aids are evidence–based clinical tools that
facilitate shared decision–making. Decision aids present therapeutic options,
including data on benefits and harms, and help patients clarify their prefer-
ences. In urology, one of the most life–altering choices faced by patients is
the selection of urinary diversion following radical cystectomy. We sought
to develop and evaluate a decision aid to address this decision.
CUAJ • June 2018 • Volume 12(6Suppl2) S93