AUA 2017: A Comparison of Post-cystectomy Recurrence and Survival in NAC-responsive MIBC vs. High-risk NMIBC Patients: Similar Pathologic Stage Yet Different Outcomes

Boston, MA ( It is known that patients with muscle-invasive bladder cancer (MIBC) who are down-staged after neoadjuvant chemotherapy (NAC) have improved survival over those who remain ≥pT2. It is uncertain whether subgroups of patients with high-risk non-MIBC (NMIBC) would also benefit from NAC. Aaron Brant, a medical student, presented a study comparing post-surgical outcomes in high-risk NMIBC patients who did not receive NAC with MIBC patients who were down-staged with NAC and without NAC.

The authors identified 334 patients with urothelial bladder cancer who were pT0, pTis, pTa, or pT1 and N0 at cystectomy from 2004-2015: 111 with cT2 who received NAC (NAC-responsive), 37 with cT2 who did not receive NAC (non-NAC-responsive), and 186 with high-grade cTis, cTa, or cT1 (high-risk NMIBC).

Compared to NAC-responsive and non-NAC-responsive patients, high-risk NMIBC patients had higher prevalence of intravesical therapy (70.4% vs. 14.1% and 13.5%, p<0.01), pure urothelial histology (92.5% vs. 80.2% and 64.9%, p<0.01), tumor ≥2 cm (19.9% vs. 6.6% and 10.8%, p<0.01), and lower prevalence of pT0 pathology (11.8% vs. 41.3% and 46%, p<0.01). Location of recurrence did not differ significantly between the groups, and 23.5% of recurrences in high-risk NMIBC patients occurred outside of the pelvis. Results demonstrated improved recurrence-free and overall survival in NAC-responsive vs. high-risk NMIBC patients (p<0.02 and p<0.02) but not in non-NAC-responsive vs. high-risk NMIBC patients (p=0.34 and p=0.43). In Cox regression, tumor ≥2 cm was independently associated with increased risk of cancer recurrence (HR=2.31, p=0.02) and overall mortality (HR=2.10, p=0.02)

In summary, patients with NAC-responsive MIBC had better post-surgical outcomes than patients with high-risk NMIBC. High-risk NMIBC patients had a higher prevalence of tumor ≥2 cm, which was an independent predictor of cancer recurrence. Despite being node negative, almost 25% of recurrences in patients with high-risk NMIBC occurred distantly. Future studies should be performed to identify whether patients with unresectable or high volume NMIBC could benefit from NAC.

Presented By: Aaron Brant, Baltimore, MD

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

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

Newsletter subscription

Free Daily and Weekly newsletters offered by content of interest

The fields of GU Oncology and Urology are rapidly advancing. Sign up today for articles, videos, conference highlights and abstracts from peer-review publications by disease and condition delivered to your inbox and read on the go.