Buenos Aires, Argentina (UroToday.com) Badrinath Konety, Professor University of Minnesota, discussed risk stratification of MIBC. Risk factors include, hydronephrosis, LVI, CIS, variant histology, cT3 disease and prior intravesical therapy.
These factors may be used to discern which patients may benefit from neoadjuvant chemotherapy versus upfront radical cystectomy. Variant histology highlights ominous nature of these tumors and strong consideration for more aggressive treatment earlier on (independent of clinical stage) to improve oncologic outcomes. Micropapillary tumors have been shown to be particularly aggressive tumors which centers have shown conflicting results regarding treatment with intravesical therapy vs. radical cystectomy in patients with NMIBC. At our center, we counsel patients with variant histology and in particular micropapillary to strongly consider radical cystectomy especially in setting of cT1 disease due to prior work showing 100% CSS vs 60% CSS if they underwent surgery vs. intravesical therapy. We also use other risk factors previously mentioned in order to determine which patients may need NAC vs. upfront radical cystectomy.
World Urological Oncology Federation Symposium at the SIU Congress 2016 - October 20 - 23, 2016 – Buenos Aires, Argentina
Written By: Stephen B. Williams, M.D., Assistant Professor in Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish Kamat, M.D. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.