Retrospective Analysis of Survival in Muscularis Propria-Invasive Bladder Cancer
Amber M D'Souza, Kamal S Pohar, Tahir Arif, Susan Geyer, Debra L Zynger. The Ohio State University Medical Center, Columbus, OH
Background: Muscularis propria-invasive bladder cancer is associated with significant morbidity and mortality. Our aim was to analyze prognostic factors in a recent cohort of radical cystectomy (RC) patients at a single institution to evaluate outcomes based on current practice patterns.
Design: Between 2007-2010, 180 radical cystectomies (RC) were performed on patients with biopsy proven pT2 disease. A retrospective analysis of overall survival (OS) was conducted upon these 180 patients utilizing Kaplan Meier survival curves and multivariable modeling.
Results: Pathologic stage at RC was pT0/a/is, n=35, 19%; pT1, n=12, 7%; pT2, n=41, 23%; pT3, n=61, 34%; pT4, n=31, 17%. At last follow-up 76 patients (42%) had died. 1.5 year OS was as follows pT0/pTis, 80%; pTa, 100%; pT1, 77%; pT2a, 80%; pT2b, 61%; pT3a, 58%; pT3b, 43%; pT4, 12%. Substaging of pT2 and pT3 showed a non-statistically significant improved survival in lower substages. Stages were collapsed into three stage groups with pT0/a/is/1/2a surviving longer than pT2b/3a/3b, and pT4 having the worst prognosis (p<0.00001). Patients with a stage based response (25%) had improved OS (p=0.00043), although in multivariable analyses collapsed RC stage group was a more significant prognostic factor than stage based response. 30% of patients were pN1+ at RC, with pN1+ as a negative predictor of survival (p<0.00001). The 1.5 year OS was 66% for pN0 and 30% for pN1+. Neoadjuvant chemotherapy (NAC), given to 45% of patients, was not associated with improved OS (p=0.746). However, in the NAC group there was more frequent downstaging comparing cT prior to RC versus pT at RC (48% vs 17%). There was a higher incidence of NAC patients with pT0 (24% vs 8%) and in the low stage group pT0/a/is/1/2a (46% vs 28%). Surprisingly, a higher incidence of pN1+ was seen with NAC (40% vs 22%). A small group of pN1+ patients were ≤pT2a at RC, and all had a history of NAC.
Conclusions: pT4 was the strongest negative predictor of survival, followed by pT2b/3a/3b and pN1+. Improved OS was seen with RC stage ≤pT2a. Positive lymph nodes were not limited to high stage disease. No survival benefit was demonstrated with NAC. NAC patients were noted to have a higher frequency of low pT stage, yet more frequent node positivity. For patients that receive NAC, pT stage may not accurately reflect tumor burden. Our findings represent treatment outcomes based on recommended guidelines outside the context of a clinical trial.
Category: Genitourinary (including renal tumors)
Monday, March 19, 2012 1:30 PM
Platform Session: Section A, Monday Afternoon