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MP13-17 CHARACTERIZING INTERMEDIATE-RISK NON-MUSCLE INVASIVE BLADDER CANCER: IMPLICATIONS FOR THE DEFINITION OF INTERMEDIATE RISK AND TREATMENT STRATEGY
THE JOURNAL OF UROLOGYâ
Vol. 195, No. 4S, Supplement, Friday, May 6, 2016
e141
(1%) TURBTs, and were all bleeding requiring coagulation (grade IIIb). Two complications occurred in the 2nd and two in the 3rd trimester, respectively. CONCLUSIONS: It is possible to decrease the rate of Tx histology after TURBT while maintaining a low complication rate by implementing a quality control programme where urologists and pathologists are motivated to retrieve detrusor muscle. Whether this decrease translates into an improved oncological outcome remains to be determined, although literature data seem to support this association. Source of Funding: None
MP13-17 CHARACTERIZING INTERMEDIATE-RISK NON-MUSCLE INVASIVE BLADDER CANCER: IMPLICATIONS FOR THE DEFINITION OF INTERMEDIATE RISK AND TREATMENT STRATEGY Kazuhiro Matsumoto*, Eiji Kikuchi, Yoshinori Yanai, Nozomi Hayakawa, Yujiro Ito, Takahiro Maeda, Hirohiko Nagata, Akira Miyajima, Mototsugu Oya, Tokyo, Japan INTRODUCTION AND OBJECTIVES: Risk stratification of low, intermediate, and high risk has been widely applied to predict the prognosis and guide additional treatment for non-muscle invasive bladder cancer (NMIBC). Although low- and high-risk categories are clearly defined, the intermediate-risk category has traditionally been composed of all patients not included in either of these categories. Therefore, intermediate-risk disease consists of a heterogeneous group of patients. METHODS: We reviewed and focused on 326 patients diagnosed with intermediate-risk NMIBC. We sub-classified these heterogeneous patients into three groups according to their clinical courses. Group A included patients with initial and multiple low-grade tumors (N¼170). Group B consisted of cases with low-grade tumor which recurred after low-risk tumor (N¼97), and Group C was composed of recurrent low-grade cases after high-risk tumor (N¼59). RESULTS: The 5-year recurrence-free survival rate was significantly lower in Group C (40%) than that in Group A (53%, p<0.01) and Group B (51%, p<0.01). Regarding the 5-year progression-free survival rate, significant differences were not observed among the groups (88%, 89%, and 91% in Groups A, B, and C, respectively). Totally, 167 patients received adjuvant bacille Calmette-Guerin (BCG) instillation and 39 received adjuvant chemo instillation. In Groups A and B, there was not a significant difference in the efficiency against tumor recurrence between BCG and chemo instillations. On the other hand, in Group C, the 5-year recurrence-free survival rates were 65% in patients receiving BCG therapy and 25% in those receiving chemotherapy, and the difference was significant (p¼0.01, Figure 1). Furthermore, Group C included 11 BCG refractory cases, and 5 of them later experienced stage progression during follow-up. CONCLUSIONS: Our sub-classification analyses indicated that intermediate-risk tumors which recurred after high-risk tumor (Group C) should be treated with adjuvant BCG therapy because of the high probability of subsequent recurrence. In addition, the definition of intermediate risk can include some BCG refractory cases. To provide prognostically useful information, the best method of risk stratification in the intermediate-risk group awaits future clinical outcome studies.
Source of Funding: none
MP13-18 THE COMPARISON BETWEEN EAU 2014 RISK CLASSIFICATION AND EORTC RISK CLASSIFICATION IN RECURRENCE-, AND PROGRESSION-FREE SURVIVAL IN JAPANESE MULTI-CENTER COHORT WITH 1,084 PATIENTS SATORU MUTO*, Takeshi Ieda, Shigeto Yanada, Fumitaka Shimizu, Shin-ichi Hisasue, Tatsuya Ogishima, Hisamitsu Ide, Raizo Yamaguchi, Shigeo Horie, Tokyo, Japan INTRODUCTION AND OBJECTIVES: Although some risk classifications to estimate the prognosis of non-muscle invasive bladder cancer (NMIBC) patients have been reported, it is not established the difference in survival rate between classifications. We investigate the difference in recurrence-free survival between EORTC (European Organization for Research and Treatment of Cancer) risk strati?cation and the classification in EAU 2014 guideline (EAU2014). METHODS: We analyzed data from patients with NMIBC between 2000 and 2013. Median follow-up periods were 31 months (IQR: 16-46). The Kaplan-Meier method with the log rank test were used to address recurrence free survival (RFS) and progression-free survival (PFS) rates according to EORTC risk classifications and EAU2014 classification. RESULTS: We included 1,084 patients (male; n ¼ 878, 80.9 %, female; n ¼ 206, 19.1 %) in this study. Median age was 71 years old (IQR: 63 e 78). In accordance with EAU 2014 classification, the number of patients with low-, intermediate-, and high-risk was 67 (6.2 %), 547 (50.5 %), and 470 (43.4 %), respectively. RFS rates at 5 years was 62.5 % for low-risk group, 42.1 % for intermediate-risk group, and 49.0% for high risk group. In accordance with EORTC recurrence risk classification, the number of patients with low-, intermediate-, and high-risk was 59 (5.4 %), 964 (88.9 %), and 61 (5.6 %), respectively. RFS rates at 5 years was 65.2 % for low-risk group, 45.2 % for intermediate-risk group, and 34.1% for high risk group. Although there are significant differences in RFS rates between risk groups of EORTC recurrence risk classification (p ¼ 0.047), there are no significant differences between risk groups of EAU 2014 risk classification (p ¼ 0.089). In regard to PFS, there are no significant differences between groups both of EORTC risk classification and EAU 2014 classifications. CONCLUSIONS: Compared with EORTC recurrence risk group strati?cation, EAU 2014 risk classification can increase the convenience and the number of patients with high-risk group. In our cohort, however, there are no significant differences between risk groups of EAU 2014 risk classification. We require the prompt establishment of the complete risk classification.
Vol. 195, No. 4S, Supplement, Friday, May 6, 2016
e141
(1%) TURBTs, and were all bleeding requiring coagulation (grade IIIb). Two complications occurred in the 2nd and two in the 3rd trimester, respectively. CONCLUSIONS: It is possible to decrease the rate of Tx histology after TURBT while maintaining a low complication rate by implementing a quality control programme where urologists and pathologists are motivated to retrieve detrusor muscle. Whether this decrease translates into an improved oncological outcome remains to be determined, although literature data seem to support this association. Source of Funding: None
MP13-17 CHARACTERIZING INTERMEDIATE-RISK NON-MUSCLE INVASIVE BLADDER CANCER: IMPLICATIONS FOR THE DEFINITION OF INTERMEDIATE RISK AND TREATMENT STRATEGY Kazuhiro Matsumoto*, Eiji Kikuchi, Yoshinori Yanai, Nozomi Hayakawa, Yujiro Ito, Takahiro Maeda, Hirohiko Nagata, Akira Miyajima, Mototsugu Oya, Tokyo, Japan INTRODUCTION AND OBJECTIVES: Risk stratification of low, intermediate, and high risk has been widely applied to predict the prognosis and guide additional treatment for non-muscle invasive bladder cancer (NMIBC). Although low- and high-risk categories are clearly defined, the intermediate-risk category has traditionally been composed of all patients not included in either of these categories. Therefore, intermediate-risk disease consists of a heterogeneous group of patients. METHODS: We reviewed and focused on 326 patients diagnosed with intermediate-risk NMIBC. We sub-classified these heterogeneous patients into three groups according to their clinical courses. Group A included patients with initial and multiple low-grade tumors (N¼170). Group B consisted of cases with low-grade tumor which recurred after low-risk tumor (N¼97), and Group C was composed of recurrent low-grade cases after high-risk tumor (N¼59). RESULTS: The 5-year recurrence-free survival rate was significantly lower in Group C (40%) than that in Group A (53%, p<0.01) and Group B (51%, p<0.01). Regarding the 5-year progression-free survival rate, significant differences were not observed among the groups (88%, 89%, and 91% in Groups A, B, and C, respectively). Totally, 167 patients received adjuvant bacille Calmette-Guerin (BCG) instillation and 39 received adjuvant chemo instillation. In Groups A and B, there was not a significant difference in the efficiency against tumor recurrence between BCG and chemo instillations. On the other hand, in Group C, the 5-year recurrence-free survival rates were 65% in patients receiving BCG therapy and 25% in those receiving chemotherapy, and the difference was significant (p¼0.01, Figure 1). Furthermore, Group C included 11 BCG refractory cases, and 5 of them later experienced stage progression during follow-up. CONCLUSIONS: Our sub-classification analyses indicated that intermediate-risk tumors which recurred after high-risk tumor (Group C) should be treated with adjuvant BCG therapy because of the high probability of subsequent recurrence. In addition, the definition of intermediate risk can include some BCG refractory cases. To provide prognostically useful information, the best method of risk stratification in the intermediate-risk group awaits future clinical outcome studies.
Source of Funding: none
MP13-18 THE COMPARISON BETWEEN EAU 2014 RISK CLASSIFICATION AND EORTC RISK CLASSIFICATION IN RECURRENCE-, AND PROGRESSION-FREE SURVIVAL IN JAPANESE MULTI-CENTER COHORT WITH 1,084 PATIENTS SATORU MUTO*, Takeshi Ieda, Shigeto Yanada, Fumitaka Shimizu, Shin-ichi Hisasue, Tatsuya Ogishima, Hisamitsu Ide, Raizo Yamaguchi, Shigeo Horie, Tokyo, Japan INTRODUCTION AND OBJECTIVES: Although some risk classifications to estimate the prognosis of non-muscle invasive bladder cancer (NMIBC) patients have been reported, it is not established the difference in survival rate between classifications. We investigate the difference in recurrence-free survival between EORTC (European Organization for Research and Treatment of Cancer) risk strati?cation and the classification in EAU 2014 guideline (EAU2014). METHODS: We analyzed data from patients with NMIBC between 2000 and 2013. Median follow-up periods were 31 months (IQR: 16-46). The Kaplan-Meier method with the log rank test were used to address recurrence free survival (RFS) and progression-free survival (PFS) rates according to EORTC risk classifications and EAU2014 classification. RESULTS: We included 1,084 patients (male; n ¼ 878, 80.9 %, female; n ¼ 206, 19.1 %) in this study. Median age was 71 years old (IQR: 63 e 78). In accordance with EAU 2014 classification, the number of patients with low-, intermediate-, and high-risk was 67 (6.2 %), 547 (50.5 %), and 470 (43.4 %), respectively. RFS rates at 5 years was 62.5 % for low-risk group, 42.1 % for intermediate-risk group, and 49.0% for high risk group. In accordance with EORTC recurrence risk classification, the number of patients with low-, intermediate-, and high-risk was 59 (5.4 %), 964 (88.9 %), and 61 (5.6 %), respectively. RFS rates at 5 years was 65.2 % for low-risk group, 45.2 % for intermediate-risk group, and 34.1% for high risk group. Although there are significant differences in RFS rates between risk groups of EORTC recurrence risk classification (p ¼ 0.047), there are no significant differences between risk groups of EAU 2014 risk classification (p ¼ 0.089). In regard to PFS, there are no significant differences between groups both of EORTC risk classification and EAU 2014 classifications. CONCLUSIONS: Compared with EORTC recurrence risk group strati?cation, EAU 2014 risk classification can increase the convenience and the number of patients with high-risk group. In our cohort, however, there are no significant differences between risk groups of EAU 2014 risk classification. We require the prompt establishment of the complete risk classification.