MP78-17 LONG-TERM ONCOLOGICAL OUTCOMES AFTER TRIMODALITY THERAPY AND RADICAL CYSTECTOMY WITH OR WITHOUT NEOADJUVANT CHEMOTHERAPY FOR MUSCLE-INVASIVE BLADDER CANCER
2018-04-01

You have accessJournal of UrologyBladder Cancer: Invasive VI1 Apr 2018MP78-17 LONG-TERM ONCOLOGICAL OUTCOMES AFTER TRIMODALITY THERAPY AND RADICAL CYSTECTOMY WITH OR WITHOUT NEOADJUVANT CHEMOTHERAPY FOR MUSCLE-INVASIVE BLADDER CANCER Omar Fahmy, Mohd Khairul-Asri, Tina Schubert, Arnulf Stenzl, Fahmy Hassan, Markus Renninger, Hubert Kübler, and Georgios Gakis Omar FahmyOmar Fahmy More articles by this author , Mohd Khairul-AsriMohd Khairul-Asri More articles by this author , Tina SchubertTina Schubert More articles by this author , Arnulf StenzlArnulf Stenzl More articles by this author , Fahmy HassanFahmy Hassan More articles by this author , Markus RenningerMarkus Renninger More articles by this author , Hubert KüblerHubert Kübler More articles by this author , and Georgios GakisGeorgios Gakis More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2565AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite many studies reported on comparable survival after tri-modality therapy and radical cystectomy for MIBC, until now, no clear evidence on the superiority of one modality exists. This study aimed to comprehensively compare the oncological long-term outcomes of tri-modality therapy (TMT) and radical cystectomy (RC) for the treatment of muscle-invasive bladder cancer (MIBC) with or without neoadjuvant chemotherapy. METHODS A systematic online search was conducted according to the PRISMA guidelines for studies reporting on outcomes after TMT and RC. 57 studies including 30,293 patients were included in this meta-analysis. The 5-year and 10-year overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) rates for TMT versus RC were compared. Risk of bias was assessed for the included non-randomized studies using the Newcastle-Ottawa Scale (NOS). Risk was stratified by score as: low ?4, medium: 4-6, or high =7-9 15. Findings of this analysis were assessed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system RESULTS The mean 10-year OS was 30.9% for TMT and 35.1% for RC (p=0.32). The mean 10-year DSS was 50.9% for TMT and 57.8% for RC (p=0.26). NAC was administered before therapy to 453 (13.3%) of 3402 TMT patients and 812 (3.0%) of 27867 RC patients (p<0.001). Complete response (CR) was achieved in 1545 (75.3%) of 2051 evaluable patients treated with TMT. Downstaging to stage =pT1 at RC was reported in 2416 (29.1%) of 8311 patients. NAC significantly increased the rate of pT0 from 20.2% to 34.3% (p=0.007) in cT2 and from 3.8% to 23.9% (p<0.001) in cT3-4. Compared to patients with CR after TMT, patients who were down staged to at least =pT1 stage at RC had higher 5-year OS (66.9% vs. 75.7%, p=0.013), DSS (78.3% vs. 88.3%, p=0.07), and RFS (52.5% vs. 75.8%, p=0.004). All the non-randomized studies included had a low risk of bias except for one that had a moderate risk. Based on the GRADE system, the quality of evidence for the results ranged between moderate and very low. CONCLUSIONS TMT can be considered as a curative and viable option for patients who are unfit for or refuse RC. Downstaging at the time of RC is significantly more likely with the use of neoadjuvant chemotherapy and is associated with improved disease-specific and overall survival compared to patients with complete response after TMT. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1044 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Omar Fahmy More articles by this author Mohd Khairul-Asri More articles by this author Tina Schubert More articles by this author Arnulf Stenzl More articles by this author Fahmy Hassan More articles by this author Markus Renninger More articles by this author Hubert Kübler More articles by this author Georgios Gakis More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...