Page 4 - CUA2019 Abstracts - Oncology-Bladder

Poster session 2: bladder Cancer

expensive since it is dosed prophylactically, regardless of whether patients MP-2.11
would develop POI. Impact of glycemic control on the recurrence and progression
Methods: A cost-utility analysis using a Markov cohort model was com- of non-muscle-invasive bladder cancer in patients with diabetes
pleted to compare alvimopan vs. routine care from the inpatient stay to 90 mellitus
days post-discharge (Fig. 1 Simplified Health States). Primary outcomes of Myung Soo Kim , Sumin Son , Tae Hee Kim , Eun Seong Jong , Young
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interest were predicted POI rate, total costs, and quality-adjusted life years Ho Seo , Seong Hyeon Yu , Se Heon Jeong , Ho Seok Chung , Ho Song
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(QALYs) gained. Secondary outcomes included nasogastric (NG) inser- Yu , Eu Chang Hwang , Sun-Ouck Kim , Kyung Jin Oh , Seung Il Jung ,
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tion, complications, emergency room (ER) presentations, and hospital re- Taek Won Kang , Dongdeuk Kwon , Kwangsung Park
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admissions. The model was populated using systematic literature review. 1 Department of Urology, Chonnam National University Medical School,
Results: Standardized to the annual cystectomy rate of 200 cases in Gwangju, Korea
Ontario, prophylactic alvimopan prevents 15.9 cases of POI, 14.9 NG Introduction: We sought to investigate the relationship between glycemic
insertions, 19.6 ER presentations, and 9.7 re-admissions. Alvimopan control and non-muscle-invasive bladder cancer (NMIBC).
provides cost-savings at $783.61 and 0.00170 QALYs per patient and Methods: From January 2004 to May 2015, 617 patients with NMIBC were
maintained these results across the inpatient stay and followup period. Of analyzed (group 1: patients without diabetes mellitus [DM], n=499; group
1000 scenarios, 95.2% were either dominant or cost-effective at $50 000/ 2: DM with preoperative Hb A1c <7, n=58; group 3: DM with preopera-
QALY. Our results were most sensitive to the cost of alvimopan, efficacy tive Hb A1c ≥7, n=60). A 1:2 propensity-score matching was performed
of alvimopan in reducing POI, and the baseline POI rate. using variables related to tumour progression, such as age, sex, body
Conclusions: Alvimopan dominated current care: it was cost-saving mass index (BMI), tumour multiplicity, size, grade, and pathological stage.
($783.61/patient), improved outcomes (events avoided), and improved Results: There was no significant difference in tumour characteristics
quality of life (0.00170 QALYs/patient). However, the largest limitation between group 1 and group 2. The tumour recurrence of group 2 was
may remain the policy application; although widely used in the United higher than of group 1 but not statistically significant, and tumour progres-
States (up to 70% adoption rate) with proven safety/efficacy data, alvi- sion was similar (33.0% vs. 44.8%, p=0.074; 11.4% vs. 12.0%, p=0.888).
mopan has not yet gained approval in Canada. Group 3 had significantly higher tumour multiplicity, pathological stage
This paper has a figure, which may be viewed online at: than group 1 (multiplicity >3, 42.4% vs. 58.3%, p=0.02; pathological
https://2019.cua.events/webapp/lecture/74 stage >T1, 30.9% vs. 43.3%, p=0.039). The tumour recurrence and pro-
gression of group 3 were higher than group 1 (33% vs. 48.3%, p=0.019;
MP-2.10 11.4% vs. 31.6%, p<0.001). After propensity score matching between
Curative therapy for muscle-invasive bladder cancer: A 21-year group 1 and group 3, there was no significant difference in the charac-
population-based analysis teristics of tumour (multiplicity >3, 59.2% vs. 58.3%, p=0.02; pathologi-
Benjamin Shiff , Ryan Sun , Oksana Harasemiw , Navdeep Tangri , Jeffery cal stage >T1, 45.8% vs. 43.3%, p=0.717) and recurrence rate (41.7%
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W. Saranchuk , Rahul Bansal , Darrel E. Drachenberg , Jay Nayak vs. 48.3%, p=0.428). However, the tumour progression of group 3 was
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1 Urology, University of Manitoba, Winnipeg, MB, Canada; Chronic significantly higher than that of group 1 (15.8% vs. 31.6%, p=0.02).
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Disease Innovation Centre, Winnipeg, MB, Canada Kaplan-Meier analysis showed significant differences in progression-free
Introduction: Approximately 25% of bladder cancers are muscle-invasive survivals between group 1 and group 3 (p=0.023).
at diagnosis, requiring further treatment beyond transurethral resection. Conclusions: Poor glycemic control was related to the shorter progression-
Definitive treatment entails either radical cystectomy or radiation therapy, free survival of patients with NMIBC.
each with or without neoadjuvant or adjuvant chemotherapy. Thus far, This paper has figures, which may be viewed online at:
neither treatment modality has proven conclusively superior with proper https://2019.cua.events/webapp/lecture/76
patient selection. In this study, we aimed to compare the survival out-
comes between surgery and radiation for bladder cancer in the context MP-2.12
of a large, province-wide cohort database. Characterization and distribution of soft tissue and nodal
Methods: We performed a retrospective cohort study by analyzing patient- recurrences after radical cystectomy
level of data from linked administrative datasets of all patients within the Chun Huang , Andreas Meier , Yamashita Rikiya , Emily Vertosick ,
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province of Manitoba who underwent radical cystectomy or radiotherapy Nicole Benfante , Daniel Sjoberg , Eugene Cha , Guido Dalbagni , Hebert
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for invasive bladder cancer from 1995–2015. The survival outcomes were Alberto Vargas , Bernard Bochner , Timothy Donahue 1
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compared between those who had cystectomy and with those treated 1 Urology Service, Memorial Sloan Kettering Cancer Center, New York,
with radiation. NY, United States; Department of Radiology, Memorial Sloan Kettering
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Results: A total of 5554 patients who were diagnosed with bladder cancer Cancer Center, New York, NY, United States; Department of Biostatistics,
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were identified. Of these, 1039 patients underwent treatment for inva- Memorial Sloan Kettering Cancer Center, New York, NY, United States
sive disease, either with radical cystectomy (n=454) or radiation therapy Introduction: Disease recurrence after radical cystectomy (RC) is associ-
(n=577). Those who underwent surgery were younger (68.1 vs. 76.8 ated with poor survival. Pelvic recurrences (PR) within the field of dis-
years; p<0.0001) and had lower Charlson comorbidity index (6.3±3.6 section are particularly concerning. The nature and spatial relation of soft
vs. 6.8±3.4; p=0.03). With a median followup time of 1.90 (0.8–5.2) years, tissue (ST) and lymph node (LN) PRs are not well-described. We char-
radical cystectomy was associated with significantly improved overall acterize the risk factors for LN and ST recurrence after RC and mapped
survival compared with radiation therapy (hazard ratio [HR] 2.65; 95% their 3D spatial locations.
confidence interval [CI] 2.27–3.01). The five-year estimated overall sur- Methods: From 2000–2014, 2257 bladder cancer patients underwent RC
vival was 51.77% following radical cystectomy compared with 17.63% at Memorial Sloan Kettering Cancer Center (MSKCC). We radiographically
with radiation therapy (p<0.001). identified all first PR, defined as a mass initially presenting in the pelvis
Conclusions: In this preliminary analysis, radical cystectomy was associ- and or retroperitoneum (RP) below the inferior mesenteric artery (IMA)
ated with superior survival compared with radiation therapy for invasive with or without distant metastasis. Using competing risk regression, we
bladder cancer. Further evaluation is required to determine the causes tested for association between first PR and pathological stage, lymph
of these differences. node (LN) status, margins, histology, and preoperative chemotherapy (PC)
against the risk of initial extrapelvic recurrence and death from other
causes prior to recurrence. Tomographic imaging provided location, size,
and nature of PR, with results collated on a vascular and pelvis map. 3D
volume-averaging visualized recurrence risk and disease burden.
Results: A total of 298 patients were found to have a first PR. Higher
pathological stage, positive LN, positive ST margin, and variant histol-
CUAJ • June 2019 • Volume 13, Issue 6(Suppl5) S91