Page 3 - CUA2018 Abstracts - Oncology-Testis

Poster session 12: Other Oncology III

Conclusions: The presence of baseline CKD is associated with an dutasteride or finasteride at time of RC, while 58 (17%) were taking met-
increased risk of ACM after RC, but does not appear to independently formin and 195 (58%) statins. There was a non–significant trend for those
influence cancer–specific outcomes. who took 5ARIs to have a lower incidence of positive margins (p=0.08)
and lymphovascular invasion (p=0.05). No significant difference in nodal
MP–12.4 status, T–stage, or presence of carcinoma in situ was found. When patients
with urothelial carcinoma variants present in the RC specimen were
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Trends and disparities in the receipt of definitive treatment for excluded, there was a significantly lower incidence of positive margins
clinically localized, muscle–invasive urothelial carcinoma (p=0.02), lymphovascular invasion (p=0.002), and perineural invasion
Ross Mason , Jon Duplisea , Bimal Bhindi , Matthew Tollefson , Houston (p=0.01) among 5ARI users. When performing identical analyses for met-
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Thompson , Jeffrey Karnes , Igor Frank , Colin Dinney , Stephen Boorjian 1 formin or statin use, no significant differences were found.
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1 Urology, Mayo Clinic, Rochester, MN, United States; Urology, MD Conclusions: This study is the first to suggest the use of 5ARIs may exert a
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Anderson Cancer Center, Houston, TX, United States protective biologic effect on the invasive properties of high–grade urothe-
Introduction: Previous studies have documented underuse of potentially lial carcinoma. Further validation and research is needed to understand
curative local therapies, including radical cystectomy (RC), partial cys- the therapeutic implications.
tectomy (PC), or chemoradiation (CR), for patients with muscle–invasive References:
urothelial carcinoma of the bladder (MIBC). Herein, we examine trends 1. Shiota M, Kiyoshima K, Yokomizo A, et al. Suppressed recurrent
in the treatment of MIBC and evaluate factors associated with the receipt bladder cancer after androgen suppression with androgen–depri-
of definitive local therapies. vation therapy or 5α–reductase inhibitor. J Urol 2017;197:308–13.
Methods: We identified all patients in the National Cancer Database who https://doi.org/10.1016/j.juro.2016.08.006
were diagnosed with cT2–cT4N0M0 MIBC between 2006 and 2014. 2. Cancer Genome Atlas Research Network. Comprehensive molec-
The proportion of patients receiving various treatment modalities over ular characterization of urothelial bladder carcinoma. Nature
time was examined and clinical and socioeconomic factors associated 2014;507:315–22. https://doi.org/10.1038/nature12965
with the receipt of definitive local therapy (defined as RC, PC, or CR) 3. Chalasani V, Chin JL, Izawa JI. Histologic variants of urothelial blad-
were evaluated. der cancer and nonurothelial histology in bladder cancer. Can Urol
Results: We identified 43 152 patients with localized MIBC, of whom 22 Assoc J 2009;3:S193–8. https://doi.org/10.5489/cuaj.1195
545 (52.3%) received definitive local treatment, including 17 157 (39.8%)
who underwent RC, 1031 (2.4%) treated with PC, and 4357 (10.1%) who
received CR. A total of 4541 (10.5%) received chemotherapy alone, 2366 MP–12.6
(5.5%) received radiation alone, and 13 700 (31.7%) received no/other Patient who progress following radical cystectomy: Who gets
treatment. We noted an increase in the proportion of patients with MIBC palliative care? Unconscious bias in referral patterns
who were treated with RC over time, from 33.1% in 2006 to 41.1% in Jesse Ory , Michael Vaculik , David Golombos , Chris Wallace , Stephen
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2014 (p<0.001), with a concurrent decrease in the proportion of patients Williams , Kara Matheson , Jim Hu , Padraic O’Malley 1
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receiving chemotherapy alone and those receiving no/other treatments 1 Urology, Dalhousie University, Halifax, NS, Canada; Urology, Stony
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(Fig. 1; available at https://cua.guide/). In multivariable analysis, factors Brook University Hospital, Stony Brook, NY, United States; Urology,
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associated with lower use of definitive local treatment included older age, University of Toronto, Toronto, ON, Canada; Urology, University of
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increased number of comorbidities, cT4 or cT2 stage (vs. cT3), African Texas Medical Branch, Galveston, TX, United States; Research Methods
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American race, no insurance or non–government insurance, and treatment Unit, Nova Scotia Health Authority, Halifax, NS, Canada; Urology, Weill
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at a non–academic facility (all p<0.01). Cornell Medical College, New York, NY, United States
Conclusions: A significant number of patients with MIBC continue to not Introduction: In patients with advanced abdominopelvic malignancies,
receive definitive local therapy. Although some of these patients may be palliative care has been shown to improve quality of life, mood, reduce
ineligible for such treatments, efforts aimed at mitigating the disparities hospital admissions, and improve survival. In 2016, the American
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identified herein may improve the outcomes for patients with MIBC. College of Clinical Oncologists recommended that all patients with
advanced malignancies receive palliative care. This study investigates fac-
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MP–12.5 tors that determine which bladder cancer patients receive palliative care.
Methods: Retrospective data were collected from the National Cancer
The influence of 5–alpha reductase inhibitor use on pathological Database. A total of 412 588 patients were identified in the database
features of muscle–invasive bladder cancer at radical cystectomy with bladder cancer; 5163 of these patients received palliative care. We
Catherine McMartin , Louis Lacombe , Vincent Fradet , Yves Fradet , used a multivariable logistic regression model to identify independent
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Michele Lodde , Paul Toren 2,3 predictors of palliative care. These included age, gender, insured status,
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1 Faculté de Médecine, Université Laval, Quebec City, QC, Canada;
2 Département de Chirurgie, Université Laval, Quebec City, QC, Canada; socioeconomic status, and hospital type and location.
3 Centre de Recherche, CHU de Québec, Quebec City, QC, Canada Results: We compared 4406 patients who received palliative care to
362 257 patients who did not. Independent predictors of palliative care
Study Groups: CHU de Québec. included: female gender (p<0.001), age under 60 (p=0.012), Medicare
Introduction: Recent research suggests 5–alpha reductase inhibitors insurance (p<0.001), low socioeconomic status (p<0.001), living in a
(5ARIs) may slow the progression of non–muscle–invasive bladder smaller city (p=0.0015), lower degree of education (p<0.001), attending an
cancer. Further, 5–alpha reductase expression is upregulated in 23% academic centre (p=0.006), and Asian or African American race (p<0.001).
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of muscle–invasive bladder cancer (MIBC) specimens from the Cancer Conclusions: In patients with a bladder malignancy, individuals who
Genome Altas (TCGA) study. In this study, we assess whether patient belong to a minority race, are uneducated, poor, under 60, on medi-
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use of 5ARIs influences the findings on surgical pathology at the time of care, attended an academic centre, or live in a city under 250 000 have
radical cystectomy(RC) for MIBC. an increased probability of receiving palliative care. Limitations of this
Methods: We retrospectively reviewed the last consecutive 572 patients study include unmeasured confounders, such as palliative care refusal
who underwent RC at our tertiary referral institution between 2009 and due to personal or cultural beliefs or lack of referral. Regardless, this
2017. Men were included who had urothelial cancer in the RC speci- study demonstrates that variables often associated with decreased social
men. Patients who underwent a RC for non–urothelial pathology (e.g., privilege unexpectedly increase the likelihood of receiving palliative care.
adenocarcinoma) or had no cancer in the specimen were excluded. Data These findings provide a unique perspective towards access to healthcare
for pathological stage and synoptic features were collected in a database, resources, which are often underused in underprivileged individuals.
as was preoperative use of 5ARIs, metformin, and statins. Chi–squared References:
tests were used to compare proportions between groups. 1. Bakitas MA, Tosteson TD, Li Z, et al. Early vs. delayed initiation of
Results: Following exclusions, our cohort included 338 men with urothe- concurrent palliative oncology care: Patient outcomes in the ENABLE
lial cancer in the RC specimen. Forty–eight (14%) patients were taking III randomized controlled trial. J Clin Onc 2017;33:13.
S132 CUAJ • June 2018 • Volume 12(6Suppl2)