AUA 2017: Bladder cancers are not all the same: de novo muscle invasive disease has improved survival compared to invasive disease progressing after intravesical therapy

Boston, MA ( The concept of progressive MIBC (P-MIBC) has been recently identified to be a risk factor for cancer specific death. This is a subset of patients who progress from NMIBC to MIBC following intravesical therapy. This SEER-Medicare based study found 97 progressive MIBC patients out of 1126 patients with pT2-4 disease on RC specimen. Although univariate analysis demonstrated differences in recurrence free survival and overall survival between the progressive and de novo MIBC patients, P-MIBC was not a risk factor for RFS, CSS, or OS on the multivariate analysis. Neoadjuvant chemotherapy was also not found to confer survival benefit in the P-MIBC patients.

It is perplexing why so few P-MIBC patients were found. This may be a clue to a more important conclusion: that RC is underused for patients failing intravesical therapy. Although no survival benefit was demonstrated in the P-MIBC patients undergoing neoadjuvant chemotherapy, this may simply be the effect of inadequate numbers included in the analysis. However, emerging evidence from MSKCC suggest that P-MIBC have different molecular signatures than de novo MIBC, which may explain their lack of response to chemotherapy. Further studies are needed to place this finding within the context of the molecular subtyping of urothelial carcinoma.

Presented by: Raj Bhanvadia, University of Chicago

Written By: Roger Li MD Urologic Oncology Fellow, Department of Urology, UT MD Anderson Cancer Center, Houston, TX
Ashish M. Kamat MD Wayne B. Duddlesten Professor, Department of Urology, UT MD Anderson Cancer Center, Houston TX

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