AUA 2013 - Session Highlights: Role of complete transurethral resection in bladder cancer prior to cystectomy: Is there benefit when giving neoadjuvant chemotherapy?

SAN DIEGO, CA USA (UroToday.com) - Dr. Andrew James and colleagues reviewed the transurethral resection (TUR) operative reports on patients with history of clinical T2-T4, N0-1 urothelial carcinoma of the bladder who eventually underwent cystectomy.

They used multivariate logistic regression analysis to determine the association of complete TUR on pT0 status at cystectomy. Models including all patients (adjusting for age, gender, race, NC, complete TUR) and a multivariate model limited to those receiving NC were performed.

A total of 168 patients underwent cystectomy, 82 of whom received NC. Complete TUR was performed in 38% of patients who did not receive NC and in 48% of patients who received NC (p= 0.17). There was no difference in age, gender, and race between groups based on complete TUR status. In the model including all patients, those receiving NC had higher likelihood of pT0 at cystectomy than those undergoing cystectomy alone (28% vs. 9%, respectively, OR 3.55, 95% CI 1.45-8.69, p < 0.01). In addition, having a complete TUR was associated with a 2-fold increase of pT0 status (OR 2.18, 95% CI 0.95-4.99, p=0.07). In the multivariate model, limited to those who received NC, there was a significant association with complete debulking and pT0 rates at cystectomy (OR: 3.24, 95% CI 1.09-9.59, p= 0.03).

Although this is a retrospective, single institutional study, authors illustrated the potential benefit of complete tumor debulking at the time of TUR before proceeding with neoadjuvant chemotherapy and radical cystectomy. With utilization of neoadjuvant chemotherapy and complete TUR debulking, cancer specific survival can potentially be further improved in patients with muscle invasive bladder cancer.

Presented by Andrew James, Franklin Lee, William Harris, Heather Cheng, Song Zhao, John Gore, Dan Lin, Michael Porter, Evan Yu, and Jonathan Wright at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA


Reported for UroToday.com by Reza Mehrazin, MD

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