Page 3 - CUA2019 Abstracts - Oncology-Bladder

2019 CUA Abstracts

MP-2.6 12.9 vs. 8.7 months; p=0.01), and having received only one line of sys-
Predictors of 90-day mortality in a contemporary cohort of temic therapy (17.5 vs. 8.5 months; p<0.0001). There was a trend towards
patients undergoing radical cystectomy for bladder cancer: worse survival in patients diagnosed with de novo metastatic disease
Results from the National Cancer database (median 11.7 vs. 10.5 months; p=0.06) and ECOG ≥2 (median 10.8 vs.
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Sandra Kim , Andrea Kokorovic , Vidit Sharma , Stephen Boorjian , 6.3 months; p=0.19).
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Ricardo A. Rendon , David Bell , Ross Mason 1 Conclusions: Metastatic UC in young patients is an aggressive entity with
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1 Urology, Dalhousie University, Halifax, NS, Canada; Urology, Mayo poor survival that appears worse than expected for the general population.
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Clinic, Rochester, MN, United States Known risk factors for mortality were validated in this cohort. Further
Introduction: Radical cystectomy (RC) represents the gold standard defini- studies are warranted to directly analyze the impact of age on outcomes.
tive treatment for localized muscle-invasive bladder cancer (MIBC), as
well as high-risk non-muscle-invasive disease. However, RC is associated MP-2.8
with a significant risk of both morbidity and mortality. Herein, we sought Required one-year effectiveness for novel therapies in Bacillus
to identify 30- and 90-day mortality rates after RC and to identify preop- Calmette-Guérin-unresponsive non-muscle-invasive bladder
erative risk factors associated with 90-day mortality in patients undergo- cancer: A decision analysis
ing RC for bladder cancer using the National Cancer Database (NCDB). Marian S. Wettstein , David Naimark , Michael A. Jewett , Lothar Lilge ,
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Methods: We identified all patients who underwent RC for non-metastatic Girish S. Kulkarni 1
urothelial carcinoma of the bladder within the NCDB between 2006 and 1 Division of Urology, Department of Surgery, Princess Margaret Cancer
2013. Mortality rates at 30 and 90 days postoperatively were determined, Centre, University Health Network, University of Toronto, Toronto, ON,
and factors associated with 90-day mortality were investigated with logis- Canada; Division of Nephrology, Department of Medicine, Sunnybrook
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tic regression models. Health Sciences Centre, University of Toronto, Toronto, ON, Canada;
Results: We identified 37 366 patients who underwent RC for urothelial 3 Department of Medical Biophysics, Princess Margaret Cancer Centre,
carcinoma between 2006 and 2013. All-cause mortality was 2.5% (936 University Health Network, University of Toronto, Toronto, ON, Canada
patients) within 30 days and 6.8% (2554 patients) within 90 days of RC. Introduction: Non-muscle-invasive bladder cancer (NMIBC) unrespon-
Mortality rates have remained stable over time (Fig. 1). In multivariable sive to intravesical Bacillus Calmette-Guérin (BCG) immunotherapy is
analysis, increased age, higher clinical T and N stage, increased Charlson- a clinical dilemma. Early radical cystectomy (ERC) provides superior
Deyo comorbidity classification, African-American race, decreased hos- oncological control but leads to a decreased postoperative quality of life
pital volume, non-academic centres, and lower patient income were all (QoL) and comes at the mortality and morbidity of the procedure. On
factors significantly associated with a higher 90-day mortality after RC. the other hand, novel therapies (NT) that aim to preserve the bladder
Other analyzed variables, such as sex and insurance type, were not found and the associated QoL are inferior regarding cancer control. The aim of
to be statistically significant risk factors for 90-day mortality. the current investigation was to find by a decision-analytic approach the
Conclusions: Older, lower-income patients with higher-stage disease, required one-year effectiveness for NT at which the quality-adjusted life
higher comorbidity index, African-American race, who undergo their RC expectancy (QALE) is comparable to ERC.
at lower hospital volume, non-academic centres are at an increased risk of Methods: We developed a seven-state Markov microsimulation model
short-term mortality after RC. These preoperative clinical variables should (cycle length: three months; discount rate: 3%) as illustrated in Fig. 1 and
be evaluated and discussed with patients diagnosed with non-metastatic simulated the two strategies “NT” and “ERC” with a cohort of 10 000
bladder cancer who are potential candidates for RC. patients. Each sampled individual was modeled by distinct age, sex, and
This paper has a figure, which may be viewed online at: tumour characteristics (T stage, grade, concomitant carcinoma in situ). We
https://2019.cua.events/webapp/lecture/71 defined the required one-year effectiveness for NT as the threshold value
where the two strategies yield an equal amount of QALE. Transition prob-
MP-2.7 abilities and utilities were obtained through literature review and expert
Clinical characteristics and outcomes for young patients with consensus. Before analysis, the model was validated and calibrated to a
advanced urothelial carcinoma cohort that underwent ERC and was followed for over 15 years.
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Cyrus Chehroudi , Jean-Michel Lavoie , Peter C. Black , Bernhard Eigl 2 Results: After calibration, our model produced a 10-year BC-specific sur-
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1 Urologic Sciences, University of British Columbia, Vancouver, BC, vival of 80%, which we considered as valid in relation to contemporary
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Canada; Medical Oncology, British Columbia Cancer Agency, Vancouver, series. The reference treatment strategy “ERC” yielded on average 10.1
BC, Canada quality-adjusted life years (Monte-Carlo standard error 0.06). We then
Introduction: The outcomes of patients with advanced urothelial car- varied the one-year effectiveness parameter in small increments across
cinoma (UC) remain poor. While UC is predominantly a disease of the a range from 0–100% and found a comparable amount of QALE in the
elderly, there is a cohort of relatively young patients whose natural history interval between 65% and 70%.
is incompletely studied. We present a multicentre series of young patients Conclusions: Our study could demonstrate that potential NT for BCG-
diagnosed with metastatic UC. unresponsive NMIBC can compete with ERC at one-year effectiveness
Methods: We identified patients from the BC Cancer Registry who had between 65% and 70%. As soon as NT reach clinical maturity, their
a diagnosis of metastatic UC at age ≤55 and received first-line cisplatin- clinical utility has to be evaluated from a cost-effectiveness perspective.
gemcitabine (Cis-Gem) from 2000–2017. Individual patient records were This paper has figures, which may be viewed online at:
reviewed for baseline characteristics, treatment, and outcomes. Kaplan- https://2019.cua.events/webapp/lecture/73
Meier analysis was conducted with log-rank tests for statistical significance.
Results: A total of 94 cases were identified, of which the majority were MP-2.9
male (78%) and smoking-related (68%). Median Eastern Cooperative Preventing postoperative ileus in radical cystectomy patients: A
Oncology Group (ECOG) score was 1 and 40% had visceral metastases cost-utility analysis of alvimopan
at diagnosis. Forty-two patients (45%) had previous cystectomy and 17% Douglas C. Cheung , Karen Chung , Jennifer Tang , Antonio Finelli
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received perioperative Cis-Gem. Nearly half of patients were unable to 1 Urology, University of Toronto, Toronto, ON, Canada; Plastic Surgery,
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complete first-line Cis-Gem due to progression (26%) and adverse events University of Toronto, Toronto, ON, Canada
(18%). Median overall and progression-free survival were 9.7 and 7.1 Introduction: Routine perioperative opioid analgesia contributes to the
months, respectively, for all patients. Thirty-three patients received sub- development of post-operative ileus (POI) in patients undergoing radical
sequent systemic therapies, mostly taxanes (n=19) or another platinum cystectomy. POI leads to poor oral intake, prolonged length of stay, and
doublet (n=9). Four patients went on to clinical trial and five received higher risk of complications. Alvimopan, a peripheral mu-opioid recep-
immunotherapy. Univariate factors associated with poor survival include tor antagonist, counteracts this effect independently of analgesia, but is
anemia (median 15 vs. 8.8 months; p=0.02), visceral metastases (median
S90 CUAJ • June 2019 • Volume 13, Issue 6(Suppl5)