Page 2 - CUA2018 Abstracts - Oncology-Other

Podium session 4: Other Oncology

34 patients who were down–staged at RC, 27(79%) received NAC. NAC Methods: Between 2010 and 2013, 118 patients with clinical stage Ta–
conferred no OS benefit (p=0.69) when considering all patients. Lower– T3 bladder cancer (BCa) were randomized, with 60 undergoing RARC
risk patients had a median OS of 100 months, with high– and highest–risk and 58 ORC. Recurrent Bca was defined according to the first site of
median OS being 41 and 21, respectively (p≤0.001). High–risk patients disease detection. Disease location was defined as: 1) distant recurrence;
receiving NAC had a survival benefit compared to those not receiving 2) local pelvic recurrence; or 3) abdominal recurrence (carcinomatosis
NAC (p=0.04). NAC provided no survival benefit in lower– and high- or abdominal wall involvement). Kaplan–Meier methods were used to
est–risk groups. estimate recurrence and cancer–specific survival after radical cystectomy
Conclusions: In this expanded cohort, NAC appears to benefit only high– (RC), and the log–rank test to compare differences in recurrence and
risk patients, as defined by our classification system. Although patho- cancer–specific survival rates.
logical down–staging occurred with NAC use, it did not translate into a Results: The median followup was 4.9 years (interquartile rnage [IQR]
survival benefit when considering all patients. 3.9, 5.9). There were 44 patients with recurrences: 25 after ORC and 19
after RARC. In total, there were 36 deaths, including 19 deaths from BCa.
POD–4.4 Overall recurrence rates and BCa–specific death rates were not statisti-
cally different between groups (p=0.4 and p=0.4, respectively). Overall,
Survival following upfront cytoreductive nephrectomy vs. we found abdominal recurrences in five RARC patients and two ORC
targeted therapy for metastatic renal cell carcinoma patients. Two of the five RARC patients with abdominal recurrences had
Bimal Bhindi , Elizabeth Habermann , Ross Mason , Brian Costello , Lance organ–confined disease, including one with HG, pTa BCa. In the ORC
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Pagliaro , Houston Thompson , Bradley Leibovich , Stephen Boorjian 1 group, both patients had non–organ–confined disease.
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1 Urology, Mayo Clinic, Rochester, MN, United States Conclusions: Our secondary analysis of cancer outcomes revealed no
Introduction: The optimal sequence of cytoreductive nephrectomy (CN) significant difference in disease recurrence rates or cancer–specific sur-
and targeted therapy (TT) for patients with metastatic renal cell carcinoma vival. Observed patterns of recurrence based on surgical technique were
(mRCC) is unknown. Herein, we compared overall survival (OS) between of interest, however, the study was not powered to establish differences in
patients with mRCC receiving initial CN with or without subsequent TT patterns of recurrence. Future studies are needed to determine if variations
vs. initial TT with or without subsequent CN. in sites of recurrence exist based on surgical technique.
Methods: The National Cancer Database was used to identify patients
diagnosed between 2006 and 2013 with RCC that was metastatic at
diagnosis who received CN, TT, or both. Those with other prior cancer POD–4.6
history were excluded. The cumulative incidence of receiving TT after CN Validation of Real–time, Intraoperative, Surgical Competence
and CN after TT were evaluated in competing risks analyses. To account (RISC) assessments linked to clinically relevant patient outcomes:
for treatment selection bias, inverse probability of treatment weighting A model of competency assessment in urology
(IPTW) was performed based on the propensity to receive initial CN or Ethan Grober , Mitchell Goldenberg , Mohammed Mahdi , Michael
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TT. OS from diagnosis was compared using Cox regression. Sensitivity Elfassy , Armando Lorenzo , Matthew Roberts , Trustin Domes , Michael
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analyses were performed. Jewett 1
Results: The cohort included 15 068 patients, of whom 6731 underwent 1 Department of Surgery, Division of Urology, Women’s College & Mount
initial CN and 8337 underwent initial TT. At six months from diagnosis, Sinai Hospital, University of Toronto, Toronto, ON, Canada
the probability of receiving TT after CN was 48.0%, with 15.3% of patients Introduction: We aimed to determine if intraoperative evaluations of tech-
having died after initial CN prior to receiving TT. Meanwhile, the prob- nical skill using Real–time, Intraoperative, Surgical Competence (RISC)
ability at six months of undergoing CN after initial TT was 4.7%, with assessments predicts clinical and operative outcomes in real patients.
44.9% of this group having died prior to undergoing CN. In the IPTW Methods: Subjects: 1) surgeons performing transurethral resection of
analysis, initial CN was associated with improved OS compared to initial bladder tumour (TURBT) and 2) patients with a bladder tumour requir-
TT (median 16.5 vs. 9.2 months; hazard ratio [HR] 0.61; 95% confidence ing TURBT. Study intervention: live TURBTs (n=187) were prospectively
interval [CI] 0.59–0.64; p<0.001). Findings were similar in all sensitivity recorded and evaluated in a blinded fashion by four urologic surgeons
analyses (propensity score matching and adjustment; regression adjust- as to the overall technical quality of the TURBT using RISC. Patients were
ment; six–month landmark analysis; clear–cell and non–clear–cell mRCC followed for 18 months for evidence of tumour recurrence. RISC scores
subsets; exclusion of patients who had metastasectomy). were correlated with case–matched clinical and operative patient out-
Conclusions: Given a greater likelihood of receiving multimodal therapy comes. The RISC assessment was developed following a blinded review
and an associated OS benefit, these data support CN as the initial approach by expert surgeons of unedited surgical videos of TURBT cases both with
for mRCC in appropriate surgical candidates. Continued efforts to establish and without bladder tumour recurrence following surgery, with the goal to
the optimal multimodal approach in these patients are warranted. identify fundamental technical skill domains influencing a tumour recur-
rence/recurrence–free state. Twenty competency domains were identified
POD–4.5 and used to create the RISC assessment. The technical skill domains com-
prising the RISC assessment were structured as a composite of previously
Oncological outcomes from a randomized controlled trial validated global rating scales and final product scores.
comparing open and robot–assisted laparoscopic radical Results: RISC scores discriminated between experienced and novice sur-
cystectomy for bladder cancer geons and correlated significantly with the number of previous surgical
Karim Marzouk , Vincent Laudone , Guido Dalbagni , Justin Lee , Machele cases performed (r=0.2; p=0.04). Bladder tumour recurrence: RISC assess-
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Donat , Jonathan Coleman , Andrew Vickers , Raul Parra , Harry Herr , ments of surgical skill during TURBT correlated significantly with rates of
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Bernard Bochner 1 cystoscopic bladder tumour recurrence (Fig. 1; available at https://cua.
1 Division of Urology, Department of Surgery, Memorial Sloan Kettering guide/). Both global ratings of surgical performance and final surgical
Cancer Center, New York, NY, United States; Department of Epidemiology product ratings were significantly higher (suggestive of superior techni-
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and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, cal skill) in cases without evidence of bladder tumour recurrence (Fig.1;
United States available at https://cua.guide/).
Introduction: There is a paucity of long–term oncological outcomes com- Conclusions: RISC assessments of surgical skills demonstrated construct
paring robot–assisted laparoscopic radical cystectomy (RARC) and open and predictive validity for bladder tumour recurrence following TURBT.
radical cystectomy (ORC). Herein, we report secondary endpoints of Similar methodology can be applied to develop RISC assessments for a
cancer–specific outcomes from our prospective, randomized trial com- variety of surgical procedures and disease states.
paring RARC and ORC.
CUAJ • June 2018 • Volume 12(6Suppl2) S61