1766 THE CLINICAL FEATURE OF WORSENING PROGRESSION IN PATIENTS WITH PTA NON-MUSCLE INVASIVE BLADDER TUMORS

Vol. 187, No. 4S, Supplement, Tuesday, May 22, 2012

patients. Overall perioperative morbidity rate was 18.5%. Most of them were not serious (haematuria and clot retention) and were classified as Clavien type I (42 cases; 75%) or II (8 cases, 14%). Higher grade complications were scarce: CCS IIIb in six cases (11%). No TURB related death was reported. Six patients were re-operated due to significant bleeding or clot retention on postoperative days 2-7. No significant association between Age, sex, ASA score, anti-coagulant treatment, BMI, tumor size, number of lesions and hospital stay with the number of complications were observed. On univariate (73.5 ⫾ 38 vs 36.7 ⫾21.6 minutes) and multivariate analysis longer operative time was the only independent parameter associated with a higher risk of CCS type I complications (OR: 1.040 per minute, 95%CI 1.025-1.055, p⫽ 0.001). CONCLUSIONS: The modified CCS represents a practical and easily applicable tool that may help urologists to classify the complications of TURB in a more objective and detailed way. In our experience, using this CCS tool, TURB is a safe procedure with a low morbidity rate. Post-operative bleeding is the most significant complication that determines a reoperation. A longer operative time is a significant risk factor for not serious post-operative complications. Source of Funding: None

1766 THE CLINICAL FEATURE OF WORSENING PROGRESSION IN PATIENTS WITH PTA NON-MUSCLE INVASIVE BLADDER TUMORS. Hiroaki Kobayashi*, Eiji Kikuchi, Takahiro Maeda, Nobuyuki Tanaka, Akira Miyajima, Ken Nakagawa, Mototsugu Oya, Tokyo, Japan INTRODUCTION AND OBJECTIVES: Few longer follow-up and large cohort studies at single academic center have addressed clinical outcomes of the patients, especially focusing on primary, low grade and Ta non-muscle invasive bladder cancer (NMIBC). METHODS: We retrospectively reviewed 198 patients with primary, low grade and Ta NMIBC between 1983 and 2008 at our institution. We defined worsening progression (WP) as confirmed TaG3, pTis, all pT1, concomitant carcinoma in situ (CIS) in recurrence, and upper urinary tract (UTR) or progression to equal to or more than pT2. We especially focused on the association between tumor recurrence and WP pattern and evaluated the predictor of WP in a large series of NMIBC with longer follow-up. RESULTS: In our study of 198 primary, low grade and Ta NMIBC (161 males and 37 females; mean age of 63.3 years), with a mean follow-up of 63.6 months (range: 3.3 to 263.9), tumor recurrence occurred in 85 (42.9%) and WP occurred in 22 (11.1%) patients. While thirteen (6.6%) patients had grade progression, eight (4.0%) patients had stage progression to pT1 and two (1.0%) patients to more than pT2. Concomitant CIS was occurred in 5 patients, UTR was seen in 2 patients (1.0%), but none of the 198 patients died of bladder cancer. The average time to WP was 57.2 months (range; 5.6-242.2), and eight of 22 patients (36.4%) had WP beyond 5 years after initial diagnosis. The 3, 5 and 10-year WP-free survival rates were not significantly different between the intravesical instillation group (93.7%, 92.3%, 81.9%) and the no adjuvant therapy group (93.4%, 92.3%, 89.2%) (p⫽0.605). Multivariate analysis demonstrated that tumor multiplicity was the only independent risk factor for WP (p⫽0.005 HR: 3.86). CONCLUSIONS: Patients with multiple tumors at the initial diagnosis have a significantly higher risk of tumor recurrence and WP. In addition, tumor recurrence and WP occurred even after 5 years of follow-up, suggesting the need for appropriate follow-up that continues for more than 5 years. Source of Funding: None

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1767 RECURRENCE AND TREATMENT PATTERNS IN PATIENTS WITH NON-MUSCLE-INVASIVE BLADDER CANCER Karim Chamie*, Mark S. Litwin, Jeffrey C. Bassett, Timothy J. Daskivich, Los Angeles, CA; Julie Lai, Jan M. Hanley, Santa Monica, CA; Badrinath R. Konety, Minneapolis, CA; Christopher S. Saigal, Los Angeles, CA INTRODUCTION AND OBJECTIVES: Patients with bladder cancer are apt to develop multiple recurrences that necessitate aggressive treatment. We examined the recurrence and progression rate, and treatment patterns in a cohort of individuals with high-grade nonmuscle-invasive bladder cancer. METHODS: Using linked SEER-Medicare data, we identified subjects with a diagnosis of high-grade non-muscle-invasive disease between 1992 and 2002 to determine recurrence and progression rates. We then used competing-risks regression analyses to examine the incidence of cystectomy, radiotherapy, and chemotherapy after each recurrence. RESULTS: Of 7,410 subjects, 4,826 (65.1%) experienced a recurrence, of which 1,909 (25.8%) experienced progression of disease. Of those that progressed, 588 (30.8%) underwent cystectomy, 551 (28.9%) underwent radiotherapy, 201 (10.5%) underwent systemic chemotherapy, and 569 (29.8%) died without undergoing any treatment. Increasing recurrences were associated with a higher rate of non-surgical aggressive treatment: increasing use of radiotherapy after the second (HR 1.53; 95% CI 1.21–1.93) and third recurrence (HR 1.59; 95% CI 1.24 –2.03) and systemic chemotherapy after the third recurrence (HR 1.97; 95% CI 1.30 –2.98). Among those subjects 66 – 69 years of age without any comorbid conditions treated at an NCI-designated cancer center with medical school affiliation for an undifferentiated T1 tumor that has recurred more than three times, approximately 58% do not undergo cystectomy or radiotherapy. CONCLUSIONS: Approximately 30% of patients who progress to invasive disease do not undergo any form of treatment. Many healthy patients younger than 70 years of age do not undergo aggressive treatment, despite aggressive tumors that have recurred multiple times. Source of Funding: This work was supported in part by the American Cancer Society (Principal Investigator: KC); Ruth L. Kirschstein National Research Service Award Extramural (Principal Investigator: KC); National Institutes of Health Loan Repayment Program (Principal Investigatory: KC); Jonsson Comprehensive Cancer Center Seed Grant (Principal Investigator: MSL); National Institute of Diabetes and Digestive and Kidney Diseases (Principal investigator: MSL)

1768 CLINICAL SIGNIFICANCE OF THE CLASSIFICATION FOR BACILLUS CALMETTE-GUE´RIN FAILURE IN NON-MUSCLE INVASIVE BLADDER CANCERS Hiroshi Shirakawa*, Eiji Kikuchi, Nobuyuki Tanaka, Kazuhiro Matsumoto, Akira Miyajima, So Nakamura, Mototsugu Oya, Tokyo, Japan INTRODUCTION AND OBJECTIVES: To investigate the differences in clinical features and subsequent stage progression and disease-specific survival among patients of BCG-failure classified as being BCG-refractory, BCG-resistant, BCG-relapsing, and BCG-intolerant according to the classification of Nieder et al (Neider AM, et al. Urology 2005; 66: 108-25). The term ‘BCG-failure’ is a heterogeneous entity and this may have an effect on inconsistent treatment-decisions and protocols. METHODS: We identified 173 initial BCG-failure patients from 521 patients who had been administered induction BCG therapy for non-muscle invasive bladder cancer excluding entirely CIS between 1987 and 2009. The patients were assigned to one of the 4 BCG-failure groups, and then we evaluated each prognostic outcome.