P025 Considerations in the cancer specific survival assessment in radical cystectomy for bladder cancer

P025 Considerations in the cancer specific survival assessment in radical cystectomy for bladder cancer

posters / european urology supplements 11 (2012) 191–235 P025 Considerations in the cancer specific survival assessment in radical cystectomy for blad...

54KB Sizes 2 Downloads 58 Views

posters / european urology supplements 11 (2012) 191–235

P025 Considerations in the cancer specific survival assessment in radical cystectomy for bladder cancer O. Rodriguez Faba, J. Palou, C. Ochoa, R. Parada, A. Wong, Ll. Gausa, H. Villavicencio. Fundaci´ o Puigvert, Dept. of Urology, Barcelona, Spain Introduction & Objectives: Pathological stage is a prognostic factor for survival in radical cystectomy (RC). Several studies have reported up to 50% of clinical understage. Usually, the information of the cancer-specific survival (CSS) curves is related to the pathological report of the RC. To evaluate and compare the CSS according to the clinical stage of TUR, the pathological stage at RC, and the higher stage evaluating both clinical and pathological stage. Material & Methods: We conducted a retrospective study of the clinic and pathological characteristics of 888 patients treated with RC between 1978 and 2009. A reclassification of the stage for each patient was made by comparing the clinical vs. pathological stage and selecting the higher of both. The analysis of survival was performed using Kaplan–Meier, and comparison of stage by Cox regression model. Results: The mean age was 62 (32–91) years, and 805 (90.7%) patients were men with a mean follow-up of 41.3 months. In the stage reclassification, selecting the highest stage, 192 (21.7%) presented stage Ta-1, Tis, and 696 (78.3%) T2–4. CSS according to the clinical stage, Ta-1/Tis patients had a CSS of 83% and T2–4 of 75–50%; According to pathological stage was 90% and 60–75% respectively. When the highest stage was selected, CSS was 83% and 75–50%. Comparing the 3 groups: Although significant (p < 0.05), clinical stage does not discriminate accurately the differences between stages; Pathological stage differenciate the non-muscle invasive tumours of the muscle invasive (p < 0.05); Finally, according to the highest stage of both, the different stages are better discriminated (p = 0.0001). Conclusions: Clinical, pathological and clinical-pathological staging are all discriminative but the last one, was better to separate significantly all the stages in bladder cancer related to cancer specific survival. The stratification with both clinical (TURBT) and pathological (cystectomy specimen) is better than only consider pathological stage. P026 Prognosis of primary and progressive muscle-invasive urothelial bladder carcinoma – Is there a difference? A. Ciudin, M.G. Diaconu, A. Molina, J. Huguet, L. Peri, M.J. Ribal, A. Alcaraz. Hospital Clinic Barcelona, Dept. of Urology, Barcelona, Spain Introduction & Objectives: Up to 20–40% of urothelial carcinomas are muscle-invasive (MI), either at initial diagnosis (85%) or progressing from a non-muscle-invasive tumor (15%). There is controversy about whether these two different forms of presentation of MI tumors have implications in the final prognosis of the patients. Our objectives were to assess in our series of radical cystectomy the characteristics and evolution of patients with primary and progressive MI bladder cancer. Material & Methods: We performed a retrospective review of 465 consecutive radical cystectomy performed in our center between 1991 and 2008. We studied 284 patients with primary MI bladder tumor and 87 bladder tumors with prrogressive MI bladder tumor. We excluded the cases with high-grade muscle-invasive tumor with progression at less then 3 months, considering they could have been understaged during the initial transurethral resection, and patients undergoing cystectomy for high-grade non-muscle-invasive bladder tumor without response to BCG. We analyzed the pathological stages of the cystectomies in both groups. We compared the 2 and 5 years cancer-specific survival in both groups globally and by patholog-

199

ical stages using the log rank of Kaplan–Meier survival curves. We performed multivariate analysis using the Cox regression to exclude bias effects of age, gender and pathological stage. Results: The mean age of the 371 MI bladder cancer patients was 64.3 years. The ratio male: female ratio of 9:1. There were no significant differences between groups in age distribution, sex and pathological stage. With a mean post-cystectomy followup of 30 months, cancer-specific survival at 2 and 5 years of total patients was 67.7% and 52.3% respectively. Cancer-specific survival at 2 and 5 years for patients with bladder cancer was 65.9% and 40.6% for progressive MI and 61.3% and 47.2% for the primary MI tumors (no significant differences). When stratified by pathological stages we encountered significant differences in survival at 2 and 5 years for patients with T4 tumor stage (57% for progressive MI tumors vs 32% for primary MI tumors, p = 0.001). Conclusions: At global level we did not observe differences in the final outcome of patients with muscle-invasive bladder cancer with primary and/or progressive muscle-invasive tumor. On the other hand in patients with T4 tumor stage there was a higher survival rate in those who have progressive tumors. P028 T4 bladder tumour affecting the prostate. Prognostic differences depending on the bladder tumour evolution: Primary versus progressive tumours A. Ciudin, J. Huguet, L. Peri, M.J. Ribal, A. Alcaraz. Hospital Clinic Barcelona, Dept. of Urology, Barcelona, Spain Introduction & Objectives: Cystectomy is the standard treatment for muscle-invasive urothelial tumors. An involvement of the prostate was described in 15–48% of the cystectomies for urothelial carcinoma. This condition occurs in two ways: – by transmural extent of the tumor from the bladder into the prostatic stroma; – by arising from the prostatic urethra, where according to the depth of invasion will affect the mucosa, ducts or stroma. Our objective was to assess whether prostatic stromal involvement occurs differently between primary (de novo muscle invasive) and progressive (muscle invasive with a history of non-muscle-invasive) tumours and also to assess if this has any impact in patients’ prognosis. Material & Methods: We performed a retrospective analysis of our cystectomy database. We reviewed 301 patients treated between January 2000 and December 2008. Inclusion criteria: 1. pT4a bladder tumors affecting the prostate; 2. only stromal involvement of the prostate was accepted, discarding the patients with involvement of the mucosa or prostatic ducts. We evaluated: prior history of non muscle invasive bladder tumour, pathological stage, treatment and outcome of these patients. Results: Of 301 patients undergoing cystectomy we identified 49 (16.27%) with tumors involving the prostatic stroma. Of these, 29 were primary invasive tumors and 20 progressive tumors. In almost all of the cases with primary invasive tumor (28 out of 29 cases – 96.6%), the involvement of the prostate was by means of extramural extension from the bladder. In one case (3.4%) the prostate was involved by extension through the prostatic urethra. In most of the cases with progressive invasive tumor (13 out of 20 patients – 65%), prostatic involvement had its origin in the prostatic urethra. In the other 7 cases (35%) there was a transmural infiltration from the bladder. More patients had positive lymph nodes in primary invasive tumors (48.27% – 14 patients versus 25% – 5 patients, p = 0.09). The 2 years and 5 years overall survival was lower in the group of primary invasive tumors when compared to progressive invasive tumors (two years: 35% versus 51% p = 0.01), (five years: 19% versus