Presentation Authors: Christopher R Haas*, New York, NY, Kevin Lee, Notre Dame, IN, Christopher B Anderson, Guarionex Joel DeCastro, James M McKiernan, New York, NY
Introduction: Prior studies have shown that patients with nonmuscle invasive bladder cancer (NMIBC) and specifically CIS who fail BCG and progress to muscle Invasive bladder cancer (secondary MIBC) do worse after radical cystectomy (RC) than patients who present with de-novo MIBC. We have previously demonstrated favorable results in a highly selected cohort of patients with clinical complete response (cCR) after neoadjuvant platinum-based chemotherapy (NAC) who forego radical cystectomy (RC) and are placed on an active surveillance and delayed intervention (ASDI) protocol. We sought to investigate whether secondary MIBC or CIS on pre-NAC TUR had worse outcomes than de-novo MIBC in our ASDI cohort.
Methods: A single institution IRB-approved urologic oncology database was retrospectively reviewed to identify secondary MIBC and CIS in a cohort of 52 cCR response ASDI patients. A cCR to NAC was defined as negative TURBT, urine cytology, and cross-sectional imaging. Patients on the ASDI protocol were followed with cystoscopy, urine cytology, and cross-sectional imaging at 3-4 month intervals. Kaplan Meier curves and cox regression models were used to identify predictors of recurrence.
Results: Secondary MIBC was identified in 14/52 (26.9%) within the ASDI cohortâ€”all but 1 had documented prior BCG treatment. CIS was present within 21/52 (40%) of pre-NAC TUR specimens. Recurrence risk was similar when stratifying by secondary MIBC vs de-novo MIBC but trended towards increased recurrence risk when stratified by CIS (HR 1.76, p = 0.111, figure 1). 5-year cancer-specific, overall, and cystectomy-free survival were similar between groups at 85%, 81% and 60%, respectively. 13/31 (42%) of recurrences were managed conservatively while the remainder underwent RC. On multivariable cox regression controlling for age and hydronephrosis, secondary MIBC was not a significant predictor (HR 0.426, p = 0.15), but CIS (HR 2.7, p = 0.012) and hydronephrosis (HR 2.9, p = 0.022) both increased risk of relapse.
Conclusions: While recent studies have suggested that secondary MIBC may be less chemosensitive than de-novo MIBC, when secondary MIBC completely responds to NAC, outcomes on the ASDI protocol are similar. A diagnosis of CIS on pre-NAC TURBT warrants heightened vigilance for recurrence should the patient pursue bladder preservation.