IBCN 2017: Outcomes

Lisbon, Portugal (UroToday.com) Laura S. Mertens from The Netherlands Cancer Institute, Amsterdam, The Netherlands presented their abstract ‘Long-Term Survival after Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Patients with Peritoneal Carcinomatosis of Urachal Cancer (UrAC)’. 48 patients with UrAC treated at our hospital between 1994-2014 were assessed. The median follow up was 74 months. Of the CRS/HIPEC patients, 4 (44.4%) developed a recurrence; 3 (33.3%) died of disease. The 2-yr and 5-yr DSSwere 75% and 63%, respectively. DSS did not significantly differ from DSS of patients without metastases who only underwent curative local treatment, but was superior to the patients with distant metastases (P = 0.034). The overall complication rate after CRS/HIPEC was 55.6%. In summary, CRS/HIPEC demonstrates satisfactory long-term oncological outcome for selected patients with PC of UrAC and may be potentially curative treatment option for this group of patients.

Stephen B. Williams from The University of Texas Medical Branch at Galveston, Galveston, Texas presented his abstract ‘Survival Differences Among Bladder Cancer Patients According to Gender: Critical Evaluation of Radical Cystectomy Use and Delay to Treatment’. A total of 9,907 patients aged 66 years or older diagnosed with clinical stage II-IV N0M0 bladder cancer from January 1, 2001 to December 31, 2011 from SEER-Medicare data were analyzed. We used multivariable regression analyses to identify factors predicting the use and delay of RC. Cox proportional hazards models were used to analyze survival outcomes. Of the 9,907 patients diagnosed with bladder cancer 3,256 (32.9%) were female. Women were significantly more likely to undergo RC across all stages compared to their male counterparts (Stage II: Relative Risk (RR) 1.48, 95% Confidence Interval (CI) = 1.33-1.65, P < 0.001; Stage III: RR 1.24, 95% CI = 1.13-1.37, p<0.001; Stage IV: RR 1.33, 95% CI = 1.19-1.49, p<0.001). Moreover, there was no significant difference in delay to RC according to gender across all clinical stages. Using propensity score matching, women had worse overall (HR 1.07, CI 1.01-1.14, p=0.024), and worse cancer-specific survival (HR 1.26, CI 1.17-1.36, p<0.001) than men, respectively. Gender differences persist with women significantly more likely to undergo RC independent of clinical stage. However, women have significantly worse survival than men. Delay from diagnosis to surgery did not account for this decreased survival among women thereby suggesting underlying biological underpinnings likely responsible for these gender-specific survival differences.

Neema Navai from MD Anderson, Houston, TX presented his abstract ‘Cost-Effectiveness of Robot-Assisted Radical Cystectomy Using a Propensity Matched Cohort’. A decision analytic model was used to compare health-related quality of life and medical costs for RARCs and OCs performed between 2007 and 2015. Propensity matching was done and a multivariate analysis was carried out. Costs were inflated to 2015 healthcare dollars. There was no difference in patient demographics or pathologic staging. Multivariable analysis revealed RARC had significantly less transfusions and complications compared to OC. RARC was $2,969 less per QALY compared to OC. While RARC was overall $17,000 more expensive, this also equated to an increase of 0.32 QALYs. One-way sensitivity analysis demonstrated RARC as the preferred strategy if RARC can prevent a complication 74% of the time. In conclusion, RARC compared to OC is cost-effective when the rate of complications and transfusions is low.

Speaker(s): Laura S. Mertens, The Netherlands Cancer Institute, Amsterdam; Stephen B. Williams,The University of Texas Medical Branch at Galveston, Galveston, Texas; Neema Navai, MD Anderson, Houston, TX

Written by: Stephen B. Williams, M.D., Associate Professor, Division of Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish M. Kamat, M.D. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX., at the International Bladder Cancer Network - October 21, 2017- Lisbon, Portugal