Page 1 - CUA2019 Abstracts - Oncology-Bladder

2019 CUA Abstr
2019 CUA AbstrACtsACts

Poster Session 2: Bladder Cancer

June 30, 2019; 0730–0900

MP-2.1 patients who refuse radical cystectomy or are medically unfit to undergo
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Effect of blood transfusions on oncological outcomes in patients surgery. According to most guidelines, a biopsy after RT is recommended
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undergoing radical cystectomy to rule out persistent or residual disease after treatment. Our objective was
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Chun Huang , Melissa Assel , Nima Almassi , Shawn R. Dason , Victor to analyze the performance of biopsy to assess response post-RT.
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A. McPherson , Lucas Dean , Daniel Sjoberg , Andrew Vickers , Bernard Methods: This was a retrospective study on patients treated with curative-
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Bochner , Eugene Cha 1 intent RT for MIBC at our institution between 2001 and 2017. Results
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1 Urology Service, Memorial Sloan Kettering Cancer Center, New York, from cross-sectional imaging, cystoscopy, urine cytology, and biopsy were
NY, United States; Department of Biostatistics, Memorial Sloan Kettering collected, and descriptive analysis was performed.
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Cancer Center, New York, NY, United States Results: After exclusion criteria, a total of 167 patients were analyzed.
Introduction: It has been suggested that blood transfusion (PRBC-T) nega- Median age was 75 years (interquartile range [IQR] 67–81). Stage reparti-
tively affects oncological outcomes after radical cystectomy (RC). We tion was 150 (90%) cT2, 12 (7%) cT3, and five (3%) cT4. Neoadjuvant
assessed the association between perioperative PRBC-T and oncological chemotherapy was given in 30 (18%) patients. Isolated RT was adminis-
outcomes in patients (pts) undergoing RC, taking into account the effects tered in four (5%) patients and 154 (92%) received trimodal therapy. First
of neoadjuvant chemotherapy (NAC). post-treatment cystoscopy and/or cytology were suspicious in 26 (15.5%)
Methods: We identified 2454 pts who underwent RC at Memorial Sloan cases and eight (42%) out of 19 biopsies in this setting were benign. On
Kettering Cancer Center (MSKCC) between 2000 and 2015 for clinically the other hand, when cystoscopy and cytology were both normal, a control
localized bladder cancer. Pts who received non-standard preoperative biopsy taken in 56 (40%) patients was able to detect residual NMIBC in
chemotherapy were excluded. PRBC-T was categorized as preoperative, six (10.7%) and MIBC in three (5.3%).
intraoperative, and postoperative. Recurrence-free (RFS) and cancer-specific Conclusions: We demonstrated that when residual disease is suspected,
survival (CSS) were analyzed using multivariable Cox models adjusting for pathology can be benign in up to 42% of biopsies, while up to 16% of
age, grade, stage, lymph node (LN) status, histology, and receipt of NAC. patients will have residual disease despite normal cystoscopy and cytol-
We performed sensitivity analyses to determine the effect of risk adjustment. ogy. A systematic routine biopsy after RT is highly recommended to assess
Results: There were differences depending on transfusion status: pts who response in all patients who are surgical candidates regardless of cystoscopy
received PRBC-T (1457, 64%) were older, had higher stage disease (all and urine cytology findings. Larger multi-institutional studies are needed
p<0.0001), and higher rates of LN involvement (p=0.0004) (Table 1). We to validate these findings.
saw a statistically significant association between PRBC-T and CSS (hazard This paper has a figure, which may be viewed online at:
ratio [HR] 1.30; 95% confidence interval [CI] 1.07, 1.58; p=0.007) though https://2019.cua.events/webapp/lecture/67
not RFS (HR 1.18; 95% CI 0.99, 1.41; p=0.052). The results were highly References
sensitive to risk adjustment. A 2.2% change in risk of cancer-specific mortal- 1. El-Achkar A, Souhami L, Kassouf W. Bladder preservation therapy:
ity caused the difference between groups to become non-significant. The Review of literature and future directions of trimodal therapy. Curr
timing of PRBC-T did not affect RFS (p=0.9) or CSS (p=0.8). Pts receiving Urol Rep 2018;19:108. https://doi.org/10.1007/s11934-018-0859-z
NAC were more likely to receive PRBC-T (75% vs. 59%; p<0.0001), but 2. Rose TL, Deal AM, Ladoire S, et al. Patterns of bladder preservation
NAC did not significantly modify the relationship between PRBC-T and therapy utilization for muscle-invasive bladder cancer. Bladder Cancer
either RFS (p=0.8) or CSS (p=0.5). 2016;2:405-13. https://doi.org/10.3233/BLC-160072
Conclusions: Given the differences between the transfused and non-trans- 3. Ploussard G, Daneshmand S, Efstathiou JA, et al. Critical analysis
fused cohorts, and sensitivity of our findings to small differences in risk- of bladder sparing with trimodal therapy in muscle-invasive bladder
adjustment, we did not find conclusive evidence that PRBC-T portends cancer: A systematic review. Eur Urol 2014;66:120-37. https://doi.
poorer oncological outcomes. We suspect that unmeasured differences org/10.1016/j.eururo.2014.02.038
were not adequately controlled for by multivariable analyses. We found 4. Alfred Witjes J, Lebret T, Comperat EM, et al. Updated 2016 EAU
no evidence that the timing of PRBC-T influenced oncological outcomes. guidelines on muscle-invasive and metastatic bladder cancer. Eur Urol
This paper has a figure, which may be viewed online at: 2017;71:462-75. https://doi.org/10.1016/j.eururo.2016.06.020
https://2019.cua.events/webapp/lecture/66 5. Chang SS, Bochner BH, Chou R, et al. Treatment of non-metastatic
muscle-invasive bladder cancer: AUA/ASCO/ASTRO/SUO guideline.
J Urol 2017;198:552-9. https://doi.org/10.1016/j.juro.2017.04.086
MP-2.2 6. Flaig TW, Spiess PE, Agarwal N, et al. NCCN guidelines insights:
Role of routine biopsy after radiation-based therapy for muscle- Bladder cancer, Version 5.2018. JNCCN 2018;16:1041-53. https://
invasive bladder cancer doi.org/10.6004/jnccn.2018.0072
Ronald Kool , Adnan El-Achkar , Gautier Marcq , Fadi Brimo , Marie
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Vanhuyse , Armen G. Aprikian , Simon Tanguay , Fabio Cury , Luis
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Souhami , Wassim Kassouf 1
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1 Urology, McGill University Health Centre, Montréal, QC, Canada; Pathology,
McGill University Health Centre, Montréal, QC, Canada; Medical Oncology,
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McGill University Health Centre, Montréal, QC, Canada; Radiation
Oncology, McGill University Health Centre, Montréal, QC, Canada
Introduction: Radiation-based therapy (RT) has emerged as a suitable
organ-sparing treatment for muscle-invasive bladder cancer (MIBC)
S88 CUAJ • June 2019 • Volume 13, Issue 6(Suppl5)
© 2019 Canadian Urological Association