Page 6 - CUA2019 Abstracts - Oncology-Bladder

Poster session 2: bladder Cancer

UP-2.2 underwent RC and 32 (29%) were treated with TMT. The RC group
Robot-assisted radical cystectomy with extracorporeal urinary had higher rates of cT3/T4 compared to those in the TMT group (59%
diversion does not increase ureteroenteric stricture rate: vs.19%; p<0.001). The median cost in the treatment phase for RC was
Outcomes from a randomized trial comparing open vs. robotic $21 911 (IQR 19 384–28 531) vs. $15 407 (IQR 14 738–16 231) for
cystectomy TMT (p<0.001). There was no significant difference between treatment
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Chun Huang , Taehyoung Lee , Melissa Assel , Victor A. McPherson , groups with respect to costs of diagnosis or workup. However, the cost of
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Sherri Donat , Harry Herr , Jonathan Coleman , Vincent Laudone , Guido followup care was higher for patients undergoing TMT compared to RC
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Dalbagni , Andrew Vickers , Bernard Bochner , Alvin Goh 1 ($5519 vs $2876, p=0.04). In a subgroup analysis for patients with cT2
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1 Urology Service, Memorial Sloan Kettering Cancer Center, New York, disease (n=57), median treatment costs for both RC and TMT remained
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NY, United States; Department of Biostatistics, Memorial Sloan Kettering largely unchanged and the difference in cost between the two modalities
Cancer Center, New York, NY, United States remained statistically significant (p<0.001).
Introduction: The rate of benign ureteroenteric anastomotic stricture Conclusions: In appropriately selected patients with MIBC where TMT is a
(UAS) after open radical cystectomy (ORC) ranges from 3–10%, with high- reasonable treatment option, costs are not prohibitive and are lower than
volume centres reporting rates close to 3–4%. There have been reports of for RC. With increasing followup time after primary treatment, the cost
higher stricture rates following robot-assisted radical cystectomy (RARC) difference between modalities may be mitigated by the need for bladder
and extracorporeal urinary diversion (ECUD). We performed an analysis surveillance and salvage therapy in the TMT cohort.
of stricture rates in a randomized cohort of ORC and RARC with ECUD References
to evaluate UAS outcomes. 1. Witjes JA, Comperat E, Cowan NC, et al. Updated 2016 EAU guide-
Methods: A total of 118 patients were randomized to undergo robotic lines on muscle-invasive and metastatic bladder cancer. Eur Urol
and open cystectomy at a single, high-volume institution from March 2016;71:462-75. https://doi.org/10.1016/j.eururo.2016.06.020
2010 to April 2013. Urinary diversion in both arms was performed by 2. Yong JHE, McGowan T, Redmond-Misner R, et al. Estimating the
an experienced open surgeon; 110 (93%) patients achieved one year costs of intensity-modulated and 3-dimensional conformal radio-
of followup. A stricture was defined as a non-malignant obstruction on therapy in Ontario. Curr Oncol 2016;23:e228-38. https://doi.
imaging, corroborated by clinical status, and requiring procedural inter- org/10.3747/co.23.2998
vention. Clinicopathologic variables, such as gender, American Society
of Anesthesiologists classification, body mass index, surgical approach, UP-2.4
diversion type, neoadjuvant chemotherapy, stage, histology, and post- Impact of neoadjuvant chemotherapy on bladder recurrences
operative complications, were obtained. Stricture rates were compared in patients managed with trimodal therapy (TMT) for muscle-
between groups by log-rank as a post-hoc analysis. invasive bladder cancer
Results: Fifty-eight and 60 patients were randomized to undergo RARC Khaled Ajib , Michael Tjong , Guan Hee Tan , Gregory Nason , Annette
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and ORC, respectively. There were five strictures identified; all occurred Erlich , Manjula Maganti , Srikala Sridhar , Neil Fleshner , Alexandre
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in patients randomized to receive ORC. The overall stricture rate was Zlotta , Alejandro Berlin , Peter Chung , Girish S. Kulkarni 1
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2.2% (per renal unit). Median time to stricture was 4.5 months and the 1 Urology, Princess Margaret Hospital, Toronto, ON, Canada; Urology,
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risk of a stricture at one year in those who underwent ORC was 9% (95% Mount Sinai Hospital, Toronto, ON, Canada
confidence interval 4%, 20%; p=0.018). Three patients were managed Introduction: Bladder preservation with trimodal therapy has emerged
endoscopically while two patients required open revision of the anasto- as an alternative treatment in patients with muscle-invasive bladder can-
mosis. There was no evidence that a perioperative grade 3–5 complication cer. We evaluated whether receipt of neoadjuvant chemotherapy (NAC)
was associated with the development of a stricture (p=1) and there was decreases local bladder recurrences.
no difference in 24-month creatinine (p=0.4). Methods: We retrospectively analyzed our bladder preservation database
Conclusions: Robotic cystectomy with extracorporeal diversion can and identified all patients with localized, pT2-T4 bladder cancer treated
achieve excellent ureteral anastomotic outcomes when performed at a with curative intent between 2003 and 2017. Patients were treated with
high-volume centre. Patients undergoing ORC were at higher risk of stric- maximal transurethral resection of bladder tumour (TURBT), followed
ture compared to those undergoing the hybrid robotic procedure. by chemotherapy/radiotherapy. Contemporary patients were also treated
with NAC. Overall recurrence-free survival (RFS) and bladder RFS were
UP-2.3 analyzed using the Kaplan-Meier method and Cox proportional hazards
Cost of muscle invasive bladder cancer treatment: Phase-specific modeling.
costs of trimodal therapy compared with radical cystectomy Results: Median age and followup periods were 72 years and 3.6 years,
Diana E. Magee , Marian S. Wettstein , Amanda Hird , Peter Chung , respectively. Fifty-four patients had NAC and concurrent chemoradia-
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Padraig Warde , Charles Catton , Alejandro Berlin , Srikala S. Sridhar , tion (group 1) vs. 70 patients who had concurrent chemoradiation only
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Alexandre Zlotta , Neil E. Fleshner , Girish S. Kulkarni 1 (group2). Carcinoma in situ (CIS) was present in 31% of the patients
1 Division of Urology, University of Toronto, Toronto, ON, Canada; in group 1 compared to 24% in group 2 (p=0.40). After treatment, 24
2 Department of Radiation Oncology, University of Toronto, Toronto, (44%) and 31 (44%) patients in groups 1 and 2, respectively, had blad-
ON, Canada; Department of Medical Oncology, University of Toronto, der tumour recurrence. Overall RFS at three years was 46% and 50%
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Toronto, ON, Canada in groups 1 and 2, respectively (p=0.70). Moreover, bRFS at three years
Introduction: Radical cystectomy (RC) is the gold standard treatment for was 55% and 69% in groups 1 and 2, respectively (p=0.27). However,
muscle-invasive bladder cancer (MIBC), but trimodal therapy (TMT) has the three-year cystectomy-free survival was similar across groups (74% in
been increasing in popularity for appropriately selected patients. As the group 1, 70% in group 2; p=0.84). Multivariate analyses found that the
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two therapeutic modalities are now well-accepted, we sought to evaluate presence of concomitant CIS (hazard ratio [HR] 2.13; 95% confidence
the micro-level costs associated with RC and TMT in adults with MIBC. interval [CI] 1.06–4.27; p=0.0036) was the primary factor associated with
Methods: All patients undergoing TMT or RC for primary treatment of local bladder recurrence (three-year bRFS 76% without CIS vs. 29% with
urothelial MIBC at a single academic centre between 2008 and 2012 were CIS). In a subgroup analysis of the patients with concomitant CIS (n=31),
included. Direct costs associated with each phase of a patient’s clinical the three-year bRFS rate was similar between patients that did and did
course were collected from the hospital’s financial department and physi- not receive NAC (31% vs. 27%; p=0.49).
cian costs were calculated based on the provincial fee schedule. Costs of Conclusions: Receipt of NAC does not obviate the risk of bladder recur-
radiation treatments were derived from previously published literature. 2 rence after TMT. Patients with CIS should be monitored especially closely
Results: A total of 111 patients were included. The median patient age for local recurrence.
was 68 (interquartile range [IQR] 61.5–76.5). Overall, 79 (71%) patients
CUAJ • June 2019 • Volume 13, Issue 6(Suppl5) S93