MP64-20 COMPLETE PATHOLOGIC RESPONSE TO NEOADJUVANT CHEMOTHERAPY FOR BLADDER CANCER: THE EFFECT OF PRE-TREATMENT CLINICAL STAGE (2015)

You have accessJournal of UrologyBladder Cancer: Natural History and Pathophysiology1 Apr 2015MP64-20 COMPLETE PATHOLOGIC RESPONSE TO NEOADJUVANT CHEMOTHERAPY FOR BLADDER CANCER: THE EFFECT OF PRE-TREATMENT CLINICAL STAGE William Parker, Phil Ho, Jonathon Melquist, Hadley Wyre, Moben Mirza, Jeffrey Holzbeierlein, Ashish Kamat, and Eugene Lee William ParkerWilliam Parker More articles by this author , Phil HoPhil Ho More articles by this author , Jonathon MelquistJonathon Melquist More articles by this author , Hadley WyreHadley Wyre More articles by this author , Moben MirzaMoben Mirza More articles by this author , Jeffrey HolzbeierleinJeffrey Holzbeierlein More articles by this author , Ashish KamatAshish Kamat More articles by this author , and Eugene LeeEugene Lee More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2331AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients who achieve a pathologic complete response (pCR) at the time of cystectomy represent the patients with the greatest benefit from neoadjuvant chemotherapy (NAC). However, despite a good prognosis, there is variability in outcomes. We evaluated the effect of pre-treatment clinical stage on survival in patients who achieve a pCR following NAC for bladder cancer. METHODS Patients treated with NAC for muscle-invasive bladder cancer were retrospectively identified from 2 institutions. Variables assessed included clinical stage, pathologic outcomes, and survival at the time of final follow-up. Clinical staging was subdivided into patients with clinically organ-confined disease (cT2N0) and non-organ-confined disease (cT2N+ and cT3-4Nany). Patients with a pathologic complete response (pT0N0Mx) were compared, based on clinical stage, utilizing Kaplan-Meier methods for actuarial survival. RESULTS 41 patients were identified as having a pCR. Of these patients, 28 had organ-confined disease and 13 had non-organ-confined disease at the time of chemotherapy initiation. With a median follow-up of 27.8 months, five (12.1%) patients recurred, four (9.8%) died of their disease, and one (2.4%) died of other causes. There was no significant difference between the two groups in recurrence-free survival. However, there was a statistically significant difference in overall survival (96.4% vs 69.2%, p= 0.03) and a trend towards significance in cancer specific survival (96.4% vs 76.9%, p=0.09) favoring patients with clinically organ-confined disease prior to chemotherapy. CONCLUSIONS Even in patients who have a complete response from NAC, non-organ-confined disease at presentation is associated with decreased overall survival. Up to now, no publications have demonstrated a difference in survival in this patient population. Increased length of follow-up and patient accrual may further highlight the disparity in survival between these two patient groups. These data underscore the potential need for a more intensive surveillance regimen in a patient population thought to have a good prognosis. Table 1. Actuarial Survival Between Patients with Clinically Organ-Confined and Non-Organ-Confined UCC of the Bladder Number Mean (Months) 1-yr 3-yr 5-yr Recurrence-Free Survival OC 2 (7.1%) 61.7 92.9% 92.9% 92.9% NOC 3 (23.1%) 61.6 91.0% 65.2% 65.2% p-value 0.30 0.21 Cancer-Specific Survival OC 1 (3.6%) 63.9 96.4% 96.4% 96.4% NOC 3 (23.1%) 54.0 100% 77.1% 38.6% p-value 0.09 0.06 Overall Survival OC 1 (3.6%) 63.9 96.4% 96.4% 96.4% NOC 4 (30.8%) 50.6 92.3% 71.2% 35.6% p-value 0.03 0.02 OC: Organ-Confined NOC: Non-Organ-Confined © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e806 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information William Parker More articles by this author Phil Ho More articles by this author Jonathon Melquist More articles by this author Hadley Wyre More articles by this author Moben Mirza More articles by this author Jeffrey Holzbeierlein More articles by this author Ashish Kamat More articles by this author Eugene Lee More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...