IBCN 2018: Molecular Markers and Clinical Outcome of Radical Cystectomy for Bladder Cancer

Rotterdam, The Netherlands (UroToday.com) Laura Mertens analyzed the prognostic value of the FGFR3 mutation and IHC markers (p53, Ki-67) in a multi-center, multilab setting. They performed a multicenter retrospective cohort study which included 904 cN0M0, chemotherapy-naive patients who underwent radical cystectomy (RC) with pelvic lymph node dissection. The FGFR3 mutation status was examined using PCR-SNaPshot. p53 and Ki-67 expression were determined by standard IHC. FGFR3 mutation status, p53 (cutoff> 10%) and Ki-67 (cut-off>20%) expression levels were correlated to clinic-pathological parameters and disease specific survival (DSS).

pT-stage was <pT2 in 80, pT2 in 241, pT3 in 410 and pT4 in 173 patients, respectively. Cancer positive nodes were found in 342 (38%) patients. The FGFR3 mutation was found in 102 RCs (11%), aberrant p53 in 639 (71%) RCs and aberrant Ki-67 in 502 (56%) RCs. The FGFR3 mutation was associated with lower pT-stage (P<0.001), G2 (P<0.001), pN0 (P=0.002) and prolonged DSS (P=0.001). Aberrant Ki-67 and p53 were associated with higher pT-stage and G3 tumors but not with pN+ or worse DSS. Significant predictors in multivariable analysis were pT-stage (HR 2.7, 95% CI: 1.6-4.5; P<0.001), LVI (HR 1.5, 95% CI: 1.2-1.8; P=0.001), pN-stage (HR 1.9, 95% CI: 1.5-2.3; P<0.001) and FGFR3 mutation status (HR 1.6, 95% CI: 1.1-2.3; P=0.018).

In summary, the FGFR3 mutation selectively identified patients with favorable BC at RC while p53 and Ki-67 expression were only associated with adverse tumor-characteristics. Tumor stage, LVI and nodal status remained strong predictors of DSS in this multi-center, multi-lab study enhancing the generalizability of their findings.

Presented by: Laura Mertens, University Health Network, Princess Margaret Hospital & Mount Sinai

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 16th Annual Meeting of the International Bladder Cancer Network (IBCN) October 11-13, 2018 - the Inntel Hotels Rotterdam Centre, Rotterdam, The Netherlands