Abstract: PD48-08
Sources of Funding: National Cancer Institute SPORE

Introduction

_x000D_ In muscle invasive bladder cancer (BC) there is an increased risk for systemic disease identified for patients with certain high risk features (HRF). We sought to identify the effect of HRF in the T1HG population who were managed with either primary BCG or upfront radical cystectomy (RC).

Methods

_x000D_ With IRB approval, a single center retrospective review was performed on all patients with BC at MDACC from 1995-2013. All patients included underwent a re-resection for T1HG disease and had presence of HRF as defined by: presence of hydronephrosis, thickening or induration felt at exam under anesthesia, presence of lymphovascular invasion, presence of prostatic ductal involvement or the presence of variant histology. Patients were considered to have had BCG therapy if they underwent 6 weeks of induction therapy and started a maintenance course. Primary outcome included overall survival (OS) and disease specific survival (DSS). Secondary outcomes include pathological outcome at RC.

Results

_x000D_ 209 patients with T1HG bladder cancer and HRF were identified, 64 patients (31%) had primary BCG and 145 (70%) had upfront RC. For patients with primary BCG, 2 had died and did not receive RC, 12 had BCG response and 50 patients had BCG failure and had a delayed RC (DRC). Median OS for primary BCG patients was 130 months vs. 137 for URC (p=0.0467 on KM). _x000D_ _x000D_ A total 195 patients underwent RC. Time from diagnosis of T1HG to RC was 1.4 months for upfront RC compared to 10.3 months for DRC (p<0.001). 22% (32/145) of URC patients, and 10% (5/50) of DRC patients extravesical disease (p=0.09). There was no significant difference in OS between RC patients who had upfront RC vs. DRC (p=0.2117). 10 year DSS post RC was 74.5% for upfront RC vs. 78% for DRC (p=0.122)._x000D_

Conclusions

_x000D_ T1HG BC with HRF is amenable to either upfront RC or primary BCG. Primary BCG is associated with worse OS compared to upfront RC. However, this includes patients who did not make it to RC. Of patients treated with BCG, 78% received RC. There was no adverse effects on outcome at DRC. This study validates the use of upfront RC in T1HG with HRF. As well, it demonstrates that primary BCG is a reasonable option as long as diligent follow up is maintained and a low threshold to proceed with RC upon recurrence is followed.

Funding

National Cancer Institute SPORE