Page 10 - CUA2019 Abstracts - Oncology-Kidney

Podium session 4: Mixed Oncology

using Student’s t-test, Chi-squared, or Fisher’s exact test. Putative risk 4. Emilsson L, Garcia-Albeniz X, Logan RW, et al. Examining bias in
factors for disease-specific and overall survival were analyzed using Cox studies of statin treatment and survival in patients with cancer. JAMA
regression, while predictors of response to NAC (defined as absence of Oncol 2018;4:63-70. https://doi.org/10.1001/jamaoncol.2017.2752
MIBC in RC specimen) were investigated using logistic regression. 5. da Silva RD, Xylinas E, Kluth L, et al. Impact of statin use on onco-
Results: Data was available for 340 patients (199 NLR ≤3, 141 NLR logic outcomes in patients with urothelial carcinoma of the bladder
>3). Other than age and rate of lymphovascular invasion, demographic treated with radical cystectomy. J Urol 2013;190:487-92. https://doi.
and preoperative characteristics did not differ significantly. More patients org/10.1016/j.juro.2013.02.003
in the NLR >3 group had residual MIBC after NAC than the NLR ≤ 3
group (70.8% vs. 58.3%,; p=0.049). In logistic regression for predictors of POD-4.4
response, NLR was the only significant risk factor (odds ratio [OR] 0.36;
p=0.003). NLR was a significant risk factor for both disease-specific and IDENTIFY: The investigation and detection of urological
overall survival (hazard ratio [HR] 2.4; p=0.006 and HR 1.8; p=0.02). neoplasia in patients referred with suspected urinary tract
Conclusions: NLR >3 is associated with a decreased response to NAC and cancer: A multicentre analysis 2 3
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worse patient outcomes, including reduced disease-specific and overall Mark Assmus , Miles Mannas , Taeweon Lee , Sinan Khadhouri , Kevin
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survival. This suggests that NLR is a simple tool that can aid in MIBC M. Gallagher , Kenneth R. MacKenzie , Taimur Shah , Chuanyu Gao ,
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risk-stratification in clinical practice. Sacha Moore , Eleanor Zimmerman , Eric Edison , Matthew Jefferies ,
Arjun K. Nambiar , John S. McGrath , Veeru Kasivisvanathan 13
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1 Department of Surgery, Division of Urology, University of Alberta,
POD-4.3 Edmonton, AB, Canada; Department of Urology, University of British
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Statin use and mortality in bladder cancer patients undergoing Columbia, Vancouver, BC, Canada; Department of Urology, Aberdeen
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radical cystectomy in Québec, 2000–2014 Royal Infirmary, Aberdeen, United Kingdom; Department of Urology,
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Michel Wissing , Ana O’Flaherty , Alice Dragomir , Simon Tanguay , Western General Hospital, Edinburgh, United Kingdom; Department of
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Wassim Kassouf , Armen G. Aprikian 1,2 Urology, Freeman Hospital, Newcastle, United Kingdom; Department
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1 Surgery, McGill University Health Centre, Montréal, QC, Canada; of Surgery and Cancer, Charing Cross Hospital, Imperial College
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2 Oncology, McGill University, Montréal, QC, Canada Healthcare NHS Trust, London, United Kingdom; Department of Urology,
Introduction: Bladder cancer (BCa) patients who use statins may have a Peterborough City Hospital, Peterborough, United Kingdom; Department
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better outcome, but the topic remains controversial, as biases may have of Urology, Wrexham Maelor Hospital, Wrexham, United Kingdom;
affected results. We studied the association of statin use with overall 9 Department of Urology, Weston General Hospital, Weston-super-Mare,
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(OS) and disease-specific survival (DSS) in a Québec cohort. United Kingdom; Department of Urology, North Middlesex Hospital,
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Methods: Using provincial health administrative databases, we identified London, United Kingdom; Department of Urology, Morriston Hospital,
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all BCa patients who underwent radical cystectomy (RC) in Québec from Swansea, United Kingdom; Department of Urology, University of Exeter
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2000–2014, and collected data from two years before RC to September Medical School, Exeter, United Kingdom; Department of Urology, West
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2016 or death. Survival analyses were conducted using the Kaplan-Meier Hertfordshire NHS Trust, London, United Kingdom
method, log-rank tests, and Cox proportional hazard models. Covariates The IDENTIFY Study Group
in the multivariable analyses were age, sex, Charlson’s comorbidity index, Introduction: The investigation of hematuria represents a huge healthcare
region of residence, year of RC, distance to hospital, hospital type (aca- burden worldwide. This study aimed to determine contemporary urinary
demic), hospital’s and surgeon’s RC volume, neoadjuvant chemotherapy, tract cancer rates and diagnostic test performance in patients referred to
and type of bladder diversion. We compared patients who received a secondary care with suspected urothelial cancer.
statin before RC or within a year following RC to never-statin users. To Methods: IDENTIFY is the largest ever prospective, international study
eliminate immortal time bias, we conducted a subgroup analysis exclud- of patients referred to secondary care with hematuria. Extensive data on
ing patients who died <1 year of RC. consecutive patients’ demographics, presenting features and diagnostic
Results: Of 3087 BCa patients included, 1448 (46.9%) were statin users. test results, were recorded.
Median OS and DSS were 2.5 years (95% confidence interval [CI] 2.1– Results: Over 11 000 patient records were collected from 111 hospi-
2.8) and 4.6 years (95% CI 3.5–5.5) for non-statin users, respectively, tals in 28 countries (December 2017 to October 2018). The prevalence
vs.4.5 years (95% CI 3.6–5.4) and 10.7 years (95% CI 9.1–not reached) of bladder cancer (BC) overall was 14.2%; 18.1% in visible hematu-
for statin users (p<0.001). In multivariable analyses, hazard ratios (HR) ria (VH), 3.7% in non-VH. Upper tract urothelial cancer (UTUC) preva-
for death and DSM were 0.83 (95% CI 0.75–0.91) and 0.81 (95% CI lence was 1% overall, renal cell carcinoma (RCC) 0.9%, and prostate
0.71–0.91), respectively, for statin users. A total of 2215 patients (71.8%) cancer 1.2%. Variables significantly associated with BCa included type
had a followup >1 year post-RC, of whom 1082 (48.8%) were statin users. of hematuria, age, smoking history, anticoagulation, storage urinary
Adjusted HR for death and DSM were 0.81 (95% CI 0.71–0.94) and 0.81 tract symptoms, and having had >1 episode of VH (25.5%) vs. only one
(95% CI 0.69–0.96), respectively, in this subgroup. OS/DSS did not differ (17.9%). UTUC was significantly associated with type of hematuria, age,
between patients who started statins after RC compared to those who smoking, and anticoagulation. The rate of BCa found in those with culture
already used statins before RC (adjusted HR 1.14; 95% CI 0.80–1.64 and proven urinary tract infections (UTIs) was 7.0%, which was significantly
1.11; 95%CI 0.72–1.70, respectively) lower than in those without UTI (19.7%). The diagnostic performance
Conclusions: Statin users had improved OS and DSS in our large BCa of ultrasound (US) and computed tomography (CT) is given in Table 1.
cohort. Conclusions: IDENTIFY provides contemporary cancer detection rates in
References a global population alongside extensive predictive data and diagnostic
1. Pastore A, Palleschi G, Fuschi A, et al. Can daily intake of aspirin test performance for multiple urological malignancies. The detailed data
and/or statins influence the behaviour of non-muscle-invasive blad- will allow complex interactions between predictive variables in order to
der cancer? A retrospective study on a cohort of patients undergoing develop a personalized approach to investigating hematuria. Ultimately,
transurethral bladder resection. BMC Cancer 2015;15:120. https:// this can improve shared decision-making and optimize cancer detection
doi.org/10.1186/s12885-015-1152-x while minimizing investigative burden.
2. Richard PO, Ahmad AE, Bashir S, et al. Effect of statins as a second- This paper has a figure, which may be viewed online at:
ary chemopreventive agent among individuals with non-muscle- https://2019.cua.events/webapp/lecture/40
invasive bladder cancer: A population-based analysis. Urol Oncol
2017;35:342-8. https://doi.org/10.1016/j.urolonc.2016.12.009
3. Crivelli JJ, Xylinas E, Kluth LA, et al. Effect of statin use on outcomes
of non-muscle-invasive bladder cancer. BJU Int 2013;112:E4-12.
https://doi.org/10.1111/bju.12150
CUAJ • June 2019 • Volume 13, Issue 6(Suppl5) S155