Login to Access Video or Poster Abstract: MP54-14
Sources of Funding: None

Introduction

Recent studies suggest that patients undergoing radical cystectomy (RC) for superficial bladder cancer that fails intravesical therapy (progressive muscle invasive disease, P-MIBC) do significantly worse than RC for de novo muscle invasive disease (DN-MIBC). We studied the impact of neoadjuvant (NAC) or adjuvant chemotherapy (AC) on survival in P-MIBC and DN-MIBC, using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database.

Methods

SEER-Medicare was used to identify patients from 2004- 2011 who underwent RC for pT2-pT4 MIBC, and their patterns of NAC and AC use. P-MIBC patients were defined as those who were pT2-pT4 on RC pathology, with a history of Bacillus Calmette-Guerin therapy (BCG) or ≥3 transurethral resection of bladder tumor (TURBT). DN-MIBC patients were those with pT2-pT4 disease on RC pathology who had no history of BCG exposure or ≤2 TURBTs prior to RC. Kaplan Meier (KM) survival analysis and multivariable Cox models were used to compare overall survival (OS), cancer specific survival (CSS), and recurrence free survival (RFS) between P-MIBC and DN-MIBC patients who underwent RC with or without chemotherapy.

Results

A total of 1,029 DN-MIBC and 97 P-MIBC patients undergoing RC were identified. Compared to DN-MIBC, P-MIBC patients had smaller primary tumors (p= 0.0009), lower cT stage (p= 0.0002), and AJCC stage (p= 0.0005). On KM analyses, P-MIBC patients had significantly worse OS (p = 0.0048), RFS (p = 0.0014), and nearly significantly worse CSS (p= 0.0724) compared to DN-MIBC (Fig. 1). On multivariable analysis, older patients (>75 vs. ≤70 years, HR=1.44, p<0.01), blacks (vs. white HR=1.54, p=0.036) and higher Charlson Deyo score (≥2 vs. 0, HR=1.59, p<0.001) were associated with shorter OS. While OS, RFS and CSS were no longer significantly different between P-MIBC and DN-MIBC on multivariate analysis, NAC before RC was associated with significantly longer OS (HR=0.71, p= 0.0150) compared to RC alone.

Conclusions

Progression to MIBC after intravesical therapy failure is associated with worse OS and RFS than DN-MIBC cases. Future studies may need to distinguish P-MIBC from DN-MIBC, as they appear to be biologically different, and NAC should be used more aggressively in the P-MIBC population before RC.

Funding

None