AUA 2017: Incompleteness Of The Transurethral Resection As A Predictor Of Adverse Pathological Features At The Time Of Radical Cystectomy: Implications For Neoadjuvant Chemotherapy Selection

Boston, MA ( Neoadjuvant chemotherapy (NAC) has been shown to provide a survival benefit to patients undergoing radical cystectomy (RC). However, this effect is more evident in patients with >= cT3 disease. Several studies have assessed factors that might help in selecting patients who could benefit more from NAC before RC. Nevertheless, none of them have investigated the importance of transurethral resection (TUR) completeness before RC. Dr. Moschini presented a study aimed to evaluate a cohort of patients treated with RC stratified according the completeness of TUR before RC.

This was a retrospective study assessing 481 patients treated with RC and bilateral pelvic lymph node dissection due to non-metastatic bladder cancer between 1990 and 2013 without NAC. Data regarding the completeness of pre-cystectomy TUR was attained. TUR were completed when possible, however, when not feasible, physicians reported this in a prospective maintained database.

Overall, TUR had been completed in 326 (67.8%) patients subsequently undergoing RC. Patients with an uncompleted TUR had higher cT3-4 disease, LVI, CIS and worse cN+ diseases. In univariate analysis, incompleteness of TUR was a predictor of LNI (odds ratio [OR]: 1.66, confidence interval [CI]: 1.08-2.55, p=0.02), adverse pathologic stage (OR: 1.78, CI: 1.21-2.62, p=0.003), and positive STSM (OR: 2.15, CI: 1.13-4.10, p=0.02). Multivariate analysis demonstrated that lack of TUR completeness was a predictor of positive STSM (OR: 2.18, CI: 1.12-4.25, p=0.02) and adverse pathologic T stage (OR: 1.57, CI: 1.03-2.40, p=0.03) but not of LNI (p=0.06).

In summary, incomplete TUR before RC represents a predictor of adverse pathologic features at RC. Physicians should consider this when trying to predict RC patients' survival and eventually the necessity of neoadjuvant chemotherapy administration.

Presented By: Marco Moschini, Milan, Italy

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre
Twitter: @Goldberghanan

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA