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1906 NEOADJUVANT SYSTEMIC THERAPY VS EARLY CYSTECTOMY? SINGLE CENTER ANALYSIS OF OUTCOMES FOLLOWING THERAPY FOR PATIENTS WITH CLINICALLY LOCALIZED MICROPAPILLARY UROTHELIAL CARCINOMA OF THE BLADDER
e762
THE JOURNAL OF UROLOGY姞
Vol. 185, No. 4S, Supplement, Tuesday, May 17, 2011
1905
1906
INCIDENCE AND SURVIVAL OF SMALL CELL BLADDER CANCER
NEOADJUVANT SYSTEMIC THERAPY VS EARLY CYSTECTOMY? SINGLE CENTER ANALYSIS OF OUTCOMES FOLLOWING THERAPY FOR PATIENTS WITH CLINICALLY LOCALIZED MICROPAPILLARY UROTHELIAL CARCINOMA OF THE BLADDER
Joshua Meeks*, Lee Zhao, John Cashy, Shilajit Kundu, Chicago, IL INTRODUCTION AND OBJECTIVES: Small cell bladder cancer (SCBC) is a rare and aggressive histologic subtype of bladder cancer thought to be derived in part from neuroendocrine cells. Given its rarity, the natural history, prognosis, and response to treatment have not been described. METHODS: From the Surveillance, Epidemiology and End Results (SEER) National Cancer Registry, 498 patients with SCBC were identified between the year of 1998 and 2007. For comparison, 33624 patients with urothelial bladder cancer (UC) were identified for comparison. RESULTS: The incidence of SCBC has increased over time from 0.8% to 2% of all cases of bladder cancer (p⫽0.0001) with an absolute increase of 14 to 77 cases per year from 1998 to 2007. The median age of diagnosis was 72 years, and 80% were male compared to 74% male of UC. The majority of patients with SCBC were white (89%). SCBC was more aggressive, with greater frequency of high grade compared to UC (42% vs. 31%), and muscle invasive disease at presentation (T2, 45% vs. 31%, p⫽0.001). In terms of treatment, a similar percentage of patients underwent radical cystectomy (18% with SCBC vs 19% with UC) and 19% had a lymph node dissection. Patients with SCBC were more likely to receive adjuvant radiotherapy (23% vs. 9%). Patients with SCBC had a higher rate of metastatic disease to regional lymph nodes (19% vs. 10%), with SCBC patients having higher rates of N1 (13% vs. 7%), N2 (6% vs. 3%) and N3 (0.4% vs. 0.3%) disease. Distant metastasis were present in 18% of SCBC compared to 7.5% in UC. At the time of diagnosis, 18% of patients with SCBC and only 8% of UC had evidence of metastatic disease. A significantly higher percentage of patients with SCBC died of bladder cancer compared to UC (54% vs. 32%, p⫽0.0001). For nearly every stage, SCBC had a higher cancer specific mortality including T1 (25% vs 14%, p⫽0.06), T2 (43% vs. 35%, p⫽0.04) and T3 (55% vs. 38%, p⫽0.02). Of those patients that died of bladder cancer, the mean time of survival was significantly shorter for SCBC (11 months vs. 15 months, p⫽0.0001). CONCLUSIONS: SCBC is a rare and aggressive form of bladder cancer, with increasing incidence. Compared to standard UC, SCBC has a higher grade, stage, rate of metastasis and cancerspecific mortality. Patients with SCBC may benefit from early aggressive multi-modal therapy.
Ranko Miocinovic*, Islam A Ghoneim, Andrew J Stephenson, Jorge A Garcia, Michael C Gong, Steven C Campbell, Donna E Hansel, Amr Fergany, Cleveland, OH INTRODUCTION AND OBJECTIVES: Micropapillary bladder cancer (MPBC) is a rare variant of urothelial carcinoma (UC) with an aggressive clinical behavior. Radical cystectomy is considered to be the standard approach for treatment of patients with localized disease, however, the role of perioperative systemic therapy is poorly defined. We analyzed treatment outcomes of patients with MPBC. METHODS: A retrospective review identified 38 consecutive patients treated at our institution for MPBC between years 2000 and 2010. Patients were analyzed for pre- and post-operative clinicopathological features, treatment course, and cancer specific survival. RESULTS: The median follow-up of surviving patients after cystectomy was 17 months (range, 2–75). At initial transurethral biopsy (TURB) 28 (74%) patients had clinical stage ⱕ cT2N0. In this group, 26 of 28 (93%) were upstaged to non-organ-confined and/or lymph nodepositive disease. Overall, 32 (86%) patients had evidence of lymph node metastasis on final pathology. Only 2 of 37 evaluable patients had organ-confined and node-negative disease at cystectomy. All patients with cTis-T1 who received initial bladder-sparing therapy with BCG had pathologically advanced disease at cystectomy. All 15 patients who received perioperative cisplatin-based chemotherapy died from metastatic disease. Five-year overall survival was 40% (95% CI: 16 – 64). CONCLUSIONS: MPBC is an aggressive disease with high likelihood of regional lymph node metastasis at initial presentation. Although radical cystectomy plays a critical role in patient management, systemic neoadjuvant chemotherapy may be a more appropriate strategy than immediate cystectomy. In view of poor response to current chemotherapy agents, development of new and effective drugs for this subset of patients may be needed. Source of Funding: None.
Prostate Cancer: Detection and Screening Moderated Poster 61 Tuesday, May 17, 2011
3:30 PM-5:30 PM
Clinical Features of Patients with Small Cell Compared to Urothelial Bladder Cancer Small Cell BCa Urothelial BCa Age (years) 72 72 Gender (%male)
80
74
1907
High Grade (%)
42
31
CORRELATION OF PCA3 AND MRI WITH BIOPSY OUTCOME
Muscle Invasion at Presentation (%)
45
31
Metastasis at Presentation (%)
18
8 10
Lymph Node Metastasis (%)
19
N1
13
7
N2
6
3
N3
.4
Distant Metastasis
18
Overall Mortality
54
Source of Funding: None
.3 7.5 32
Gisele Leyten, Lieske Wierenga, Michiel Sedelaar*, Inge van Oort, Jurgen Fu¨tterer, Jelle Barentsz, Jack Schalken, Peter Mulders, Nijmegen, Netherlands INTRODUCTION AND OBJECTIVES: PCA3 is a biomarker and MRI an imaging modality, that can be useful for predicting presence of cancer in repeat prostate biopsies. We studied the use of the Progensa® PCA3 test in a clinical academic setting. This is the first study of the combined use of PCA3 with (functional) magnetic resonance imaging (MRI) staging to predict biopsy outcome. METHODS: All patients that had a Progensa® PCA3 test in the urological outpatient clinic at the Radboud University Nijmegen Medical Centre between May 2006 and December 2009 were evaluated retrospectively. The PCA3 score was correlated to clinical and pathological outcome and in a subgroup the combination with MRI was studied. The non-parametric Mann-Whitney U test and linear regression modeling were used to assess significance levels.
THE JOURNAL OF UROLOGY姞
Vol. 185, No. 4S, Supplement, Tuesday, May 17, 2011
1905
1906
INCIDENCE AND SURVIVAL OF SMALL CELL BLADDER CANCER
NEOADJUVANT SYSTEMIC THERAPY VS EARLY CYSTECTOMY? SINGLE CENTER ANALYSIS OF OUTCOMES FOLLOWING THERAPY FOR PATIENTS WITH CLINICALLY LOCALIZED MICROPAPILLARY UROTHELIAL CARCINOMA OF THE BLADDER
Joshua Meeks*, Lee Zhao, John Cashy, Shilajit Kundu, Chicago, IL INTRODUCTION AND OBJECTIVES: Small cell bladder cancer (SCBC) is a rare and aggressive histologic subtype of bladder cancer thought to be derived in part from neuroendocrine cells. Given its rarity, the natural history, prognosis, and response to treatment have not been described. METHODS: From the Surveillance, Epidemiology and End Results (SEER) National Cancer Registry, 498 patients with SCBC were identified between the year of 1998 and 2007. For comparison, 33624 patients with urothelial bladder cancer (UC) were identified for comparison. RESULTS: The incidence of SCBC has increased over time from 0.8% to 2% of all cases of bladder cancer (p⫽0.0001) with an absolute increase of 14 to 77 cases per year from 1998 to 2007. The median age of diagnosis was 72 years, and 80% were male compared to 74% male of UC. The majority of patients with SCBC were white (89%). SCBC was more aggressive, with greater frequency of high grade compared to UC (42% vs. 31%), and muscle invasive disease at presentation (T2, 45% vs. 31%, p⫽0.001). In terms of treatment, a similar percentage of patients underwent radical cystectomy (18% with SCBC vs 19% with UC) and 19% had a lymph node dissection. Patients with SCBC were more likely to receive adjuvant radiotherapy (23% vs. 9%). Patients with SCBC had a higher rate of metastatic disease to regional lymph nodes (19% vs. 10%), with SCBC patients having higher rates of N1 (13% vs. 7%), N2 (6% vs. 3%) and N3 (0.4% vs. 0.3%) disease. Distant metastasis were present in 18% of SCBC compared to 7.5% in UC. At the time of diagnosis, 18% of patients with SCBC and only 8% of UC had evidence of metastatic disease. A significantly higher percentage of patients with SCBC died of bladder cancer compared to UC (54% vs. 32%, p⫽0.0001). For nearly every stage, SCBC had a higher cancer specific mortality including T1 (25% vs 14%, p⫽0.06), T2 (43% vs. 35%, p⫽0.04) and T3 (55% vs. 38%, p⫽0.02). Of those patients that died of bladder cancer, the mean time of survival was significantly shorter for SCBC (11 months vs. 15 months, p⫽0.0001). CONCLUSIONS: SCBC is a rare and aggressive form of bladder cancer, with increasing incidence. Compared to standard UC, SCBC has a higher grade, stage, rate of metastasis and cancerspecific mortality. Patients with SCBC may benefit from early aggressive multi-modal therapy.
Ranko Miocinovic*, Islam A Ghoneim, Andrew J Stephenson, Jorge A Garcia, Michael C Gong, Steven C Campbell, Donna E Hansel, Amr Fergany, Cleveland, OH INTRODUCTION AND OBJECTIVES: Micropapillary bladder cancer (MPBC) is a rare variant of urothelial carcinoma (UC) with an aggressive clinical behavior. Radical cystectomy is considered to be the standard approach for treatment of patients with localized disease, however, the role of perioperative systemic therapy is poorly defined. We analyzed treatment outcomes of patients with MPBC. METHODS: A retrospective review identified 38 consecutive patients treated at our institution for MPBC between years 2000 and 2010. Patients were analyzed for pre- and post-operative clinicopathological features, treatment course, and cancer specific survival. RESULTS: The median follow-up of surviving patients after cystectomy was 17 months (range, 2–75). At initial transurethral biopsy (TURB) 28 (74%) patients had clinical stage ⱕ cT2N0. In this group, 26 of 28 (93%) were upstaged to non-organ-confined and/or lymph nodepositive disease. Overall, 32 (86%) patients had evidence of lymph node metastasis on final pathology. Only 2 of 37 evaluable patients had organ-confined and node-negative disease at cystectomy. All patients with cTis-T1 who received initial bladder-sparing therapy with BCG had pathologically advanced disease at cystectomy. All 15 patients who received perioperative cisplatin-based chemotherapy died from metastatic disease. Five-year overall survival was 40% (95% CI: 16 – 64). CONCLUSIONS: MPBC is an aggressive disease with high likelihood of regional lymph node metastasis at initial presentation. Although radical cystectomy plays a critical role in patient management, systemic neoadjuvant chemotherapy may be a more appropriate strategy than immediate cystectomy. In view of poor response to current chemotherapy agents, development of new and effective drugs for this subset of patients may be needed. Source of Funding: None.
Prostate Cancer: Detection and Screening Moderated Poster 61 Tuesday, May 17, 2011
3:30 PM-5:30 PM
Clinical Features of Patients with Small Cell Compared to Urothelial Bladder Cancer Small Cell BCa Urothelial BCa Age (years) 72 72 Gender (%male)
80
74
1907
High Grade (%)
42
31
CORRELATION OF PCA3 AND MRI WITH BIOPSY OUTCOME
Muscle Invasion at Presentation (%)
45
31
Metastasis at Presentation (%)
18
8 10
Lymph Node Metastasis (%)
19
N1
13
7
N2
6
3
N3
.4
Distant Metastasis
18
Overall Mortality
54
Source of Funding: None
.3 7.5 32
Gisele Leyten, Lieske Wierenga, Michiel Sedelaar*, Inge van Oort, Jurgen Fu¨tterer, Jelle Barentsz, Jack Schalken, Peter Mulders, Nijmegen, Netherlands INTRODUCTION AND OBJECTIVES: PCA3 is a biomarker and MRI an imaging modality, that can be useful for predicting presence of cancer in repeat prostate biopsies. We studied the use of the Progensa® PCA3 test in a clinical academic setting. This is the first study of the combined use of PCA3 with (functional) magnetic resonance imaging (MRI) staging to predict biopsy outcome. METHODS: All patients that had a Progensa® PCA3 test in the urological outpatient clinic at the Radboud University Nijmegen Medical Centre between May 2006 and December 2009 were evaluated retrospectively. The PCA3 score was correlated to clinical and pathological outcome and in a subgroup the combination with MRI was studied. The non-parametric Mann-Whitney U test and linear regression modeling were used to assess significance levels.