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MP38-08 PROGNOSTICS FACTORS OF POSITIVES URETERAL SECTION DURING CYSTECTOMY FOR BLADDER CANCER.
THE JOURNAL OF UROLOGYâ
Vol. 195, No. 4S, Supplement, Sunday, May 8, 2016
not present in pelvic irrigation but in intra-vesical wash. These cells were detected in the pelvis in 1 patient with advanced disease. Active enrollment in this study continues which will allow better understanding of local spread of bladder cancer. Source of Funding: Roswell Park Alliance Foundation
MP38-06 COMPARING LONG-TERM ONCOLOGIC OUTCOMES BETWEEN OPEN RADICAL CYSTECTOMY AND ROBOT-ASSISTED LAPAROSCOPIC RADICAL CYSTECTOMY: A RANDOMIZED CLINICAL TRIAL Justin Lee*, Bernard Bochner, Daniel Sjoberg, Nick Liu, Guido Dalbagni, Jonathan Silberstein, Gal Karen-Paz, S. Machele Donat, Jonathan Coleman, Sheila Mathew, Andrew Vickers, Raul Parra, Harry Herr, Vincent Laudone, New York, NY INTRODUCTION AND OBJECTIVES: In a randomized trial comparing robot-assisted laproscopic radical cystectomy (RARC) to open radical cystectomy (ORC), we excluded the possibility of large differences in 90-day perioperative outcomes. There is a paucity of long-term oncologic outcomes comparing RARC and ORC and are limited to retrospective reports. Herein, we report the outcomes from a prospective, randomized clinical trial comparing RARC and ORC. METHODS: Among the 124 patients with clinical stage Ta-T3 bladder cancer (BCa) enrolled in the trial between 2010 and 2013, a total of 118 patients were randomized with 60 in the RARC group and 58 in the ORC group. The median follow-up for survivors was 40 months (IQR 32, 51). Kaplan-Meier methods were used to estimate recurrence and cancer-specific survival probabilities after radical cystectomy (RC), and the log-rank test was used to compare differences in recurrence and cancer-specific survival rates between the two randomization groups. Greenwood’s variance estimates were used to calculate confidence intervals for differences in recurrence and cancerspecific survival rates after RC. RESULTS: Pre-treatment patient characteristic were balanced between groups such as age, gender, body mass index, and ASA score. Seventeen patients (28%) in the RARC group and 19 patients (33%) in the ORC group had pT3 or higher disease following cystectomy. In total, there were 40 BCa recurrences and 21 deaths from BCa. We did not find evidence that recurrence rates or rates of death from BCa differed between the RARC and ORC arms (p¼0.4 and p¼0.5, respectively). Risk of recurrence 24 months after RARC and ORC were 25% and 29%, respectively (difference -3.7%; 95% CI: -20%, 13%). The risk of death from BCa was 7.2% in the RARC arm and 11% in the ORC arm (difference -3.4%, 95% CI: -14%, 7.1%). The wide confidence intervals around the difference in recurrence risk preclude us from making conclusions regarding oncologic equivalence of the surgical modalities. CONCLUSIONS: In this randomized trial, we found no significant difference between recurrence rates or cancer-specific survival between RARC and ORC. Patterns in locations of recurrence are further being explored.
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Source of Funding: Sidney Kimmel Center for Prostate and Urologic Cancers at Memorial Sloan Kettering Cancer Center, Pin Down Bladder Cancer, and the Michael and Zena Wiener for Therapeutics Program in Bladder Cancer.
MP38-07 MEASURING THE DEPTH OF TUMOR INVASION MAY HAVE GREATER PROGNOSTIC VALUE THAN AJCC/UICC STAGING OF BLADDER CANCER. Nishikimi Toshinori*, Nagoya, Aichi, Japan; Tsuzuki Toyonori, NAGOYA, Japan; Kashiwagi Yuuta, Okazaki, Japan; Sassa Naoto, NAGOYA, Japan; Kimura Toru, Nagoya, Japan; Fukatsu Akitoshi, KOMAKI, Japan; Tanaka Kuniaki, Kariya, Japan; Hattori Ryohei, Gotoh Momokazu, NAGOYA, Japan INTRODUCTION AND OBJECTIVES: AJCC/UICC staging system is the gold standard to predict patient outcomes. However, many studies report that pT staging (pT2 vs. pT3) may not be a useful prognostic factor. In addition, a recent study showed that pathological criteria of distinction between pT2 and pT3 are variable among pathologists. METHODS: We recruited patients with invasive bladder cancer (pT2 and pT3) who underwent total cystectomy without prior chemotherapy or radiation therapy at authors’ hospitals from May 2004 to December 2013. The depth of tumor invasion was measured from the normal urothelium to the deepest invaded lesion. Data on the patients’ age, depth of tumor invasion (<10 mm vs. >10 mm), pT stage (pT2 vs. pT3), 1973 WHO grade (G2 or G3), and lymph node status (pN0 vs. pN1) were analyzed. Multivariate Cox proportional hazard regression models were developed to predict the progressionfree survival (PFS), cancer-specific survival (CSS), and overall survival (OS). RESULTS: The median age of the patients was 71 years (range, 35-87 years). The median follow-up period was 32 months (range, 1-247 months). A total of 72 patients developed recurrence, 55 died of the disease, and 14 died of other causes. Pathological characteristics were as follows: the median depth of tumor invasion was 10.80 mm (range 2.57-37.14 mm), pT (pT2:pT3 ¼ 45:92), 1973 WHO grade (G2:G3 ¼ 31:106). On univariate analysis, the depth of tumor invasion was associated with PFS (p ¼ .0002), CSS (p ¼ .0371), and OS (p ¼ .0284). In contrast, pT staging was not associated with PFS (p ¼ .0551), CSS (p ¼ .5030), or OS (p ¼ .6279). On multivariate analysis, the depth of tumor invasion was significantly associated with PFS (p ¼ .0063) and OS (p ¼ .0229), but not significantly associated with CSS (p ¼ .0565). pN status was significantly associated with CSS (p ¼ .0027) and OS (p ¼ .0111). pT staging was not associated with PFS (p ¼ .7638), CSS (p ¼ .5124), or OS (p ¼ .4002). CONCLUSIONS: The depth of tumor invasion (<10 mm vs. >10 mm) can be a novel staging criterion for bladder cancer that is more accurate than AJCC/UICC staging (pT2 vs. pT3). Source of Funding: none
MP38-08 PROGNOSTICS FACTORS OF POSITIVES URETERAL SECTION DURING CYSTECTOMY FOR BLADDER CANCER. francois thomas*, alezra eric, forzini thomas, saint fabien, amiens, France INTRODUCTION AND OBJECTIVES: radical cystectomy is the standard treatment for muscle invasive bladder cancer. Analysis of ureterals sections ensures intraoperative or postoperative no residual carcinoma of the urinary tract. There are no specific recommendations on prognostics factors of positive ureteral section justifying the frozen section. Objectives: Identify the prognostic factors of tumor reached ureteral section. To evaluate the sensitivity and specificity of frozen section during radical cystectomy. METHODS: : single-center retrospective study, involving 441 cystectomy (cystoprostatectomy or anterior pelvectomy) for bladder cancer between 1980 and 2013. The parameters studied were: age,
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gender, histological type, stage, grade, tumor location, presence of Cis, te ro- hydronephrosis, number of previous bladder resection, ureteral ure frozen section analysis and final ureteral analysis. RESULTS: Mean follow-up was 36.2 months [12-255]. Pathological stages were: 91pT2, 163pT3, 73pT4 among which 111 patients were N +. The average age was 65.3 years [35-87]. The ureteral frozen section was proposed for 178 renal units (173 negative and 5 positive). The final review of ureteral section included 566 renal units (24 positive and 542 negative) and has always confirmed the results of the frozen section (sensitivity and specificity of 100%). Cis was associated with bladder tumor in 12% of cases (n ¼ 54). Uretero-hydronephrosis unilateral or bilateral was present in 33.6% of cases (n ¼ 148). In univariate analysis only hydronephrosis (p ¼ 0.002) and the presence of CIS (p ¼ 0.06) were associated with the risk of ureteral recoupes positive. The specificity, sensitivity, NPV and PPV of the uretero-hydronephrosis Cisassociation for the result of the ureteral cuts was 96% respectively 33%, 99% and 14%. In multivariate analysis only the Cis was an independent prognostic factor for ureteral intersects positive (p ¼ 0.02) (OR ¼ 0.26 [0.08 to 0.80]). CONCLUSIONS: The absence of CIS and uretero-hydronephrosis eliminates 99% the risk of ureteral intersects positive and the need for a frozen section. The presence of Cis is the only independent factor overlaps ureteral positive. Source of Funding: none
MP38-09 DOES THE ILEAL LENGTH USED FOR NEOBLADDER RECONSTRUCTION AFTER RADICAL CYSTECTOMY IMPACT ON POSTOPERATIVE BOWEL HABITS ? - A COMPARISON BETWEEN THE STUDER- AND THE I-POUCH Johannes Mischinger*, Tuebingen, Germany; Mohamed Abdelhafez, €fer, Stefan Aufderklamm, Assiut, Egypt; Tilman Todenho Steffen Rausch, Christian Schwentner, Arnulf Stenzl, Georgios Gakis, Tuebingen, Germany INTRODUCTION AND OBJECTIVES: The aim of the study was to investigate whether the length of ileum used for neobladder reconstruction after radical cystectomy (RC) for bladder cancer (60cm vs. 40cm) impacts on postoperative bowel function. METHODS: In this cross sectional study, a total of 56 patients who received an ileal neobladder after RC for BC between 2003 and 2011 were investigated (Studer (S)-Pouch: 23 patients, 19 men, 4 women; I-Pouch: 33 patients; 26 men, 7 women)). Changes perioperative bowel habits were retrospectively evaluated by the validated Gastrotintestinal Quality of Life Index (GIQLI). In addition, preoperative comorbidities were assessed by the Charlson Comobidity Index (CCI) and surgical complications as graded by the Clavien-Dindo classification. RESULTS: I-Pouch patients tended to have a higher CCI compared to S-Pouch patients (defined as CCI>¼3; S-Pouch: 8/23, 34% vs. I-Pouch: 20/33, 61%; p¼0.055). No significant differences were observed for 30-day major- (S: 5/23, 22% vs. I: 4/33, 12%; p¼0.33) and minor (S: 5/23, 22% vs. I: 7/33, 21%; p¼0.96) complication rates as well as 90-day major (S: 2/23, 9%) vs. I: 0/33, 0%; p¼0.08) and minor (S: 2/ 23, 9% vs. I: 0/33, 0%; p¼0.08) complication rates between both types of neobladder. Patients with an S-Pouch reported on higher preoperative stool frequency (S: median 3, IQR 2-4; I: median 4, IQR 3-4; p¼0.035) and urgency (S: median 3, IQR 2.75-4; I: 4, IQR: 3-4; p¼0.032). No significant differences in postoperative bowel disorders were found between both neobladder types (S-Pouch: median: 16, IQR: 14-18.5; I: median: 18, IQR: 14-20; p¼0.50). CONCLUSIONS: In this analysis, I-pouch patients tended to present with more comorbidities prior to RC while S-Pouch suffered more frequently from bowel disorders preoperatively. However, perioperative complication rates and bowel habits were similar between both orthotopic bladder substitutes. These data suggest that the length of ileum used for neobladder reconstruction does not impact per se on bowel function after RC. Source of Funding: none
Vol. 195, No. 4S, Supplement, Sunday, May 8, 2016
MP38-10 CYSTECTOMY ASSOCIATED WITH IMPROVED OVERALL SURVIVAL IN VERY ELDERLY PATIENTS WITH MUSCLE INVASIVE BLADDER CANCER; RESULTS FROM THE NATIONAL CANCER DATA BASE Bream Matthew*, Matthew Maurice, Simon Kim, Hui Zhu, Robert Abouassaly, Cleveland, OH INTRODUCTION AND OBJECTIVES: Cystectomy offers a survival advantage for muscle invasive bladder cancer (MIBC), but it is unclear if the very elderly receive this benefit given the competing risks of death, and morbidity of major surgical intervention in this population. We sought to assess overall survival (OS) in elderly patients with MIBC by treatment type. METHODS: From the National Cancer Data Base (NCDB), we selected a cohort of patients age 75 and older, diagnosed with T2-T4, non-metastatic urothelial bladder cancer from 2003 to 2012 who received cystectomy, primary chemoradiation, or non-standard treatment (neither cystectomy nor chemoradiation). The effect of treatment on overall survival (OS) was determined unadjusted using Kaplan-Meier analysis and the log-rank test, and adjusted using a Cox proportional hazards model. RESULTS: Of a total of 18,945 patients with MIBC, 3898 (21%) received cystectomy, 2482 (13%) received chemoradiation therapy, and the remaining 12,565 (66%) received non-standard treatment. Median OS for the entire cohort was 14.7 months. Median OS (95% CI) was 26.5 months (23.1-28.9) for cystectomy, 22.1 months (20.1-24.2) for chemoradiation, and 12.0 months (11.3-12.7) for non-standard treatment (p<0.0001, Figure 1). A survival benefit for cystectomy over non-standard treatment was seen in all Charlson comorbidity groups. In the Cox proportional hazards model, the hazard ratio for death when compared to non-standard treatment was 0.69 (95% CI 0.63-0.75, p<0.0001) for cystectomy and 0.75 (95% CI 0.70-0.82, p<0.0001) for chemoradiation. CONCLUSIONS: Cystectomy confers an OS benefit on very elderly patients with MIBC that persists when accounting for competing risks of death. These data support the continued use of cystectomy in appropriately selected elderly patients.
Source of Funding: None
MP38-11 ONCOLOGICAL TRIFECTA AND PENTAFECTA CRITERIA IN A CONTEMPORARY COHORT OF BLADDER CANCER PATIENTS AFTER RADICAL CYSTECTOMY Julian Hanske*, Nicolas von Landenberg, Sebastian Berg, €ri Palisaar, Jana Schmidt, Marko Brock, Christian von Bodman, Ju Florian Roghmann, Joachim Noldus, Herne, Germany INTRODUCTION AND OBJECTIVES: To assess the rate and readily available preoperative predictors of trifecta and pentafecta
Vol. 195, No. 4S, Supplement, Sunday, May 8, 2016
not present in pelvic irrigation but in intra-vesical wash. These cells were detected in the pelvis in 1 patient with advanced disease. Active enrollment in this study continues which will allow better understanding of local spread of bladder cancer. Source of Funding: Roswell Park Alliance Foundation
MP38-06 COMPARING LONG-TERM ONCOLOGIC OUTCOMES BETWEEN OPEN RADICAL CYSTECTOMY AND ROBOT-ASSISTED LAPAROSCOPIC RADICAL CYSTECTOMY: A RANDOMIZED CLINICAL TRIAL Justin Lee*, Bernard Bochner, Daniel Sjoberg, Nick Liu, Guido Dalbagni, Jonathan Silberstein, Gal Karen-Paz, S. Machele Donat, Jonathan Coleman, Sheila Mathew, Andrew Vickers, Raul Parra, Harry Herr, Vincent Laudone, New York, NY INTRODUCTION AND OBJECTIVES: In a randomized trial comparing robot-assisted laproscopic radical cystectomy (RARC) to open radical cystectomy (ORC), we excluded the possibility of large differences in 90-day perioperative outcomes. There is a paucity of long-term oncologic outcomes comparing RARC and ORC and are limited to retrospective reports. Herein, we report the outcomes from a prospective, randomized clinical trial comparing RARC and ORC. METHODS: Among the 124 patients with clinical stage Ta-T3 bladder cancer (BCa) enrolled in the trial between 2010 and 2013, a total of 118 patients were randomized with 60 in the RARC group and 58 in the ORC group. The median follow-up for survivors was 40 months (IQR 32, 51). Kaplan-Meier methods were used to estimate recurrence and cancer-specific survival probabilities after radical cystectomy (RC), and the log-rank test was used to compare differences in recurrence and cancer-specific survival rates between the two randomization groups. Greenwood’s variance estimates were used to calculate confidence intervals for differences in recurrence and cancerspecific survival rates after RC. RESULTS: Pre-treatment patient characteristic were balanced between groups such as age, gender, body mass index, and ASA score. Seventeen patients (28%) in the RARC group and 19 patients (33%) in the ORC group had pT3 or higher disease following cystectomy. In total, there were 40 BCa recurrences and 21 deaths from BCa. We did not find evidence that recurrence rates or rates of death from BCa differed between the RARC and ORC arms (p¼0.4 and p¼0.5, respectively). Risk of recurrence 24 months after RARC and ORC were 25% and 29%, respectively (difference -3.7%; 95% CI: -20%, 13%). The risk of death from BCa was 7.2% in the RARC arm and 11% in the ORC arm (difference -3.4%, 95% CI: -14%, 7.1%). The wide confidence intervals around the difference in recurrence risk preclude us from making conclusions regarding oncologic equivalence of the surgical modalities. CONCLUSIONS: In this randomized trial, we found no significant difference between recurrence rates or cancer-specific survival between RARC and ORC. Patterns in locations of recurrence are further being explored.
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Source of Funding: Sidney Kimmel Center for Prostate and Urologic Cancers at Memorial Sloan Kettering Cancer Center, Pin Down Bladder Cancer, and the Michael and Zena Wiener for Therapeutics Program in Bladder Cancer.
MP38-07 MEASURING THE DEPTH OF TUMOR INVASION MAY HAVE GREATER PROGNOSTIC VALUE THAN AJCC/UICC STAGING OF BLADDER CANCER. Nishikimi Toshinori*, Nagoya, Aichi, Japan; Tsuzuki Toyonori, NAGOYA, Japan; Kashiwagi Yuuta, Okazaki, Japan; Sassa Naoto, NAGOYA, Japan; Kimura Toru, Nagoya, Japan; Fukatsu Akitoshi, KOMAKI, Japan; Tanaka Kuniaki, Kariya, Japan; Hattori Ryohei, Gotoh Momokazu, NAGOYA, Japan INTRODUCTION AND OBJECTIVES: AJCC/UICC staging system is the gold standard to predict patient outcomes. However, many studies report that pT staging (pT2 vs. pT3) may not be a useful prognostic factor. In addition, a recent study showed that pathological criteria of distinction between pT2 and pT3 are variable among pathologists. METHODS: We recruited patients with invasive bladder cancer (pT2 and pT3) who underwent total cystectomy without prior chemotherapy or radiation therapy at authors’ hospitals from May 2004 to December 2013. The depth of tumor invasion was measured from the normal urothelium to the deepest invaded lesion. Data on the patients’ age, depth of tumor invasion (<10 mm vs. >10 mm), pT stage (pT2 vs. pT3), 1973 WHO grade (G2 or G3), and lymph node status (pN0 vs. pN1) were analyzed. Multivariate Cox proportional hazard regression models were developed to predict the progressionfree survival (PFS), cancer-specific survival (CSS), and overall survival (OS). RESULTS: The median age of the patients was 71 years (range, 35-87 years). The median follow-up period was 32 months (range, 1-247 months). A total of 72 patients developed recurrence, 55 died of the disease, and 14 died of other causes. Pathological characteristics were as follows: the median depth of tumor invasion was 10.80 mm (range 2.57-37.14 mm), pT (pT2:pT3 ¼ 45:92), 1973 WHO grade (G2:G3 ¼ 31:106). On univariate analysis, the depth of tumor invasion was associated with PFS (p ¼ .0002), CSS (p ¼ .0371), and OS (p ¼ .0284). In contrast, pT staging was not associated with PFS (p ¼ .0551), CSS (p ¼ .5030), or OS (p ¼ .6279). On multivariate analysis, the depth of tumor invasion was significantly associated with PFS (p ¼ .0063) and OS (p ¼ .0229), but not significantly associated with CSS (p ¼ .0565). pN status was significantly associated with CSS (p ¼ .0027) and OS (p ¼ .0111). pT staging was not associated with PFS (p ¼ .7638), CSS (p ¼ .5124), or OS (p ¼ .4002). CONCLUSIONS: The depth of tumor invasion (<10 mm vs. >10 mm) can be a novel staging criterion for bladder cancer that is more accurate than AJCC/UICC staging (pT2 vs. pT3). Source of Funding: none
MP38-08 PROGNOSTICS FACTORS OF POSITIVES URETERAL SECTION DURING CYSTECTOMY FOR BLADDER CANCER. francois thomas*, alezra eric, forzini thomas, saint fabien, amiens, France INTRODUCTION AND OBJECTIVES: radical cystectomy is the standard treatment for muscle invasive bladder cancer. Analysis of ureterals sections ensures intraoperative or postoperative no residual carcinoma of the urinary tract. There are no specific recommendations on prognostics factors of positive ureteral section justifying the frozen section. Objectives: Identify the prognostic factors of tumor reached ureteral section. To evaluate the sensitivity and specificity of frozen section during radical cystectomy. METHODS: : single-center retrospective study, involving 441 cystectomy (cystoprostatectomy or anterior pelvectomy) for bladder cancer between 1980 and 2013. The parameters studied were: age,
THE JOURNAL OF UROLOGYâ
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gender, histological type, stage, grade, tumor location, presence of Cis, te ro- hydronephrosis, number of previous bladder resection, ureteral ure frozen section analysis and final ureteral analysis. RESULTS: Mean follow-up was 36.2 months [12-255]. Pathological stages were: 91pT2, 163pT3, 73pT4 among which 111 patients were N +. The average age was 65.3 years [35-87]. The ureteral frozen section was proposed for 178 renal units (173 negative and 5 positive). The final review of ureteral section included 566 renal units (24 positive and 542 negative) and has always confirmed the results of the frozen section (sensitivity and specificity of 100%). Cis was associated with bladder tumor in 12% of cases (n ¼ 54). Uretero-hydronephrosis unilateral or bilateral was present in 33.6% of cases (n ¼ 148). In univariate analysis only hydronephrosis (p ¼ 0.002) and the presence of CIS (p ¼ 0.06) were associated with the risk of ureteral recoupes positive. The specificity, sensitivity, NPV and PPV of the uretero-hydronephrosis Cisassociation for the result of the ureteral cuts was 96% respectively 33%, 99% and 14%. In multivariate analysis only the Cis was an independent prognostic factor for ureteral intersects positive (p ¼ 0.02) (OR ¼ 0.26 [0.08 to 0.80]). CONCLUSIONS: The absence of CIS and uretero-hydronephrosis eliminates 99% the risk of ureteral intersects positive and the need for a frozen section. The presence of Cis is the only independent factor overlaps ureteral positive. Source of Funding: none
MP38-09 DOES THE ILEAL LENGTH USED FOR NEOBLADDER RECONSTRUCTION AFTER RADICAL CYSTECTOMY IMPACT ON POSTOPERATIVE BOWEL HABITS ? - A COMPARISON BETWEEN THE STUDER- AND THE I-POUCH Johannes Mischinger*, Tuebingen, Germany; Mohamed Abdelhafez, €fer, Stefan Aufderklamm, Assiut, Egypt; Tilman Todenho Steffen Rausch, Christian Schwentner, Arnulf Stenzl, Georgios Gakis, Tuebingen, Germany INTRODUCTION AND OBJECTIVES: The aim of the study was to investigate whether the length of ileum used for neobladder reconstruction after radical cystectomy (RC) for bladder cancer (60cm vs. 40cm) impacts on postoperative bowel function. METHODS: In this cross sectional study, a total of 56 patients who received an ileal neobladder after RC for BC between 2003 and 2011 were investigated (Studer (S)-Pouch: 23 patients, 19 men, 4 women; I-Pouch: 33 patients; 26 men, 7 women)). Changes perioperative bowel habits were retrospectively evaluated by the validated Gastrotintestinal Quality of Life Index (GIQLI). In addition, preoperative comorbidities were assessed by the Charlson Comobidity Index (CCI) and surgical complications as graded by the Clavien-Dindo classification. RESULTS: I-Pouch patients tended to have a higher CCI compared to S-Pouch patients (defined as CCI>¼3; S-Pouch: 8/23, 34% vs. I-Pouch: 20/33, 61%; p¼0.055). No significant differences were observed for 30-day major- (S: 5/23, 22% vs. I: 4/33, 12%; p¼0.33) and minor (S: 5/23, 22% vs. I: 7/33, 21%; p¼0.96) complication rates as well as 90-day major (S: 2/23, 9%) vs. I: 0/33, 0%; p¼0.08) and minor (S: 2/ 23, 9% vs. I: 0/33, 0%; p¼0.08) complication rates between both types of neobladder. Patients with an S-Pouch reported on higher preoperative stool frequency (S: median 3, IQR 2-4; I: median 4, IQR 3-4; p¼0.035) and urgency (S: median 3, IQR 2.75-4; I: 4, IQR: 3-4; p¼0.032). No significant differences in postoperative bowel disorders were found between both neobladder types (S-Pouch: median: 16, IQR: 14-18.5; I: median: 18, IQR: 14-20; p¼0.50). CONCLUSIONS: In this analysis, I-pouch patients tended to present with more comorbidities prior to RC while S-Pouch suffered more frequently from bowel disorders preoperatively. However, perioperative complication rates and bowel habits were similar between both orthotopic bladder substitutes. These data suggest that the length of ileum used for neobladder reconstruction does not impact per se on bowel function after RC. Source of Funding: none
Vol. 195, No. 4S, Supplement, Sunday, May 8, 2016
MP38-10 CYSTECTOMY ASSOCIATED WITH IMPROVED OVERALL SURVIVAL IN VERY ELDERLY PATIENTS WITH MUSCLE INVASIVE BLADDER CANCER; RESULTS FROM THE NATIONAL CANCER DATA BASE Bream Matthew*, Matthew Maurice, Simon Kim, Hui Zhu, Robert Abouassaly, Cleveland, OH INTRODUCTION AND OBJECTIVES: Cystectomy offers a survival advantage for muscle invasive bladder cancer (MIBC), but it is unclear if the very elderly receive this benefit given the competing risks of death, and morbidity of major surgical intervention in this population. We sought to assess overall survival (OS) in elderly patients with MIBC by treatment type. METHODS: From the National Cancer Data Base (NCDB), we selected a cohort of patients age 75 and older, diagnosed with T2-T4, non-metastatic urothelial bladder cancer from 2003 to 2012 who received cystectomy, primary chemoradiation, or non-standard treatment (neither cystectomy nor chemoradiation). The effect of treatment on overall survival (OS) was determined unadjusted using Kaplan-Meier analysis and the log-rank test, and adjusted using a Cox proportional hazards model. RESULTS: Of a total of 18,945 patients with MIBC, 3898 (21%) received cystectomy, 2482 (13%) received chemoradiation therapy, and the remaining 12,565 (66%) received non-standard treatment. Median OS for the entire cohort was 14.7 months. Median OS (95% CI) was 26.5 months (23.1-28.9) for cystectomy, 22.1 months (20.1-24.2) for chemoradiation, and 12.0 months (11.3-12.7) for non-standard treatment (p<0.0001, Figure 1). A survival benefit for cystectomy over non-standard treatment was seen in all Charlson comorbidity groups. In the Cox proportional hazards model, the hazard ratio for death when compared to non-standard treatment was 0.69 (95% CI 0.63-0.75, p<0.0001) for cystectomy and 0.75 (95% CI 0.70-0.82, p<0.0001) for chemoradiation. CONCLUSIONS: Cystectomy confers an OS benefit on very elderly patients with MIBC that persists when accounting for competing risks of death. These data support the continued use of cystectomy in appropriately selected elderly patients.
Source of Funding: None
MP38-11 ONCOLOGICAL TRIFECTA AND PENTAFECTA CRITERIA IN A CONTEMPORARY COHORT OF BLADDER CANCER PATIENTS AFTER RADICAL CYSTECTOMY Julian Hanske*, Nicolas von Landenberg, Sebastian Berg, €ri Palisaar, Jana Schmidt, Marko Brock, Christian von Bodman, Ju Florian Roghmann, Joachim Noldus, Herne, Germany INTRODUCTION AND OBJECTIVES: To assess the rate and readily available preoperative predictors of trifecta and pentafecta