Presentation Authors: Osama Alalao*, Catrina Mueller-Leonhard, Providence, RI, Simon P. Kim, Aurora, CO, Ali Amin, Christopher Tucci, Gyan Pareek, Anthony Mega, Dragan Golijanin, Boris Gershman, Providence, RI
Introduction: Clinically node-positive (cN+) bladder cancer is considered Stage IV disease and the mainstay of treatment is chemotherapy. However, a subset of patients undergoes consolidative radical cystectomy (RC). We examined the clinical outcomes of patients with cN+ bladder cancer treated with chemotherapy and RC and developed a risk prediction model to facilitate risk-stratification and management.
Methods: We identified adult patients with cTany cN1-3 cM0 urothelial carcinoma of the bladder treated with systemic chemotherapy followed by RC from 2004-2014 in the NCDB. The associations of clinicopathologic features with overall survival (OS) were evaluated using Cox regression, and a simplified risk score was developed.
Results: A total of 491 patients received chemotherapy followed by RC. Median age was 62 years, and the median number of lymph nodes removed was 15 (IQR 8, 24). At RC, 10% of patients were ypT0, and 35% were ypN0. Over a median follow-up of 18.7 (IQR 8, 39) months, 160 patients died of any cause. 1-, 5-, and 8-year OS were 69%, 34%, and 29%, respectively. On multivariable analysis, pT stage (HR 2.48; p=0.002; HR 1.92; p=0.01 for pT4 and pT3 vs 3 ranged from 11% to 65% (Figure).
Conclusions: Survival for patients with cN+ bladder cancer treated with chemotherapy and RC is highly variable, ranging from 11% to 65% at 5 years depending on clinicopathologic features. A simplified risk score can facilitate post-operative risk-stratification and selection of patients for adjuvant therapies.