Presentation Authors: Anojan Navaratnam*, Kyle Rose, Haidar Abdul-Muhsin, Kassem Faraj, Laila Elias, Amit Syal, Sarah Eversman, Michael Patton, Mark Tyson, Erik Castle, Phoenix, AZ
Introduction: The use of neoadjuvant chemotherapy (NAC) prior to cystectomy for urothelial cancer of the bladder is recommended for all patients with clinical stage(c) T2+ disease in all major urologic guidelines. Analysis from the National Cancer Database of the United States revealed only 20.8% with cT2+ disease were receiving NAC in 2010. This study aimed to determine the trends and impact on outcomes of the &[Prime]neoadjuvant chemotherapy era&[Prime] for patients with cT2+ urothelial cancer of the bladder undergoing radical cystectomy.
Methods: The retrospective cystectomy database at Mayo Clinic Arizona was queried for all patients who underwent radical cystectomy between January 2002 and December 2014. Overall, 656 patients underwent cystectomy with 338 having radical cystectomy for cT2+ disease. We compared patients and outcomes in the &[Prime]preNAC era&[Prime] (2002-2007) vs &[Prime]NAC era&[Prime] (2008-2014). We assessed changes in overall survival between the two subgroups. Data was analyzed using Kaplan-Meier with log-rank test, Chi-square test and odds ratios with 95% confidence interval.
Results: There was an increase in rate of NAC use from 9.4% to 48.6% (p < 0.001) from the &[Prime]preNAC&[Prime] to &[Prime]NAC&[Prime] eras. Figure 1 demonstrates the year by year trends. There was an increased rate of complete response (downstage to pT0) from 9.4% to 16.2% (p=0.076) between the two eras. Across all eras, patients who received NAC were more likely to be downstaged (OR 2.89 [95% confidence interval 1.74-4.81], p < 0.001) or achieve T0 (OR 3.73 [95% CI 1.96 â€“ 7.09], p < 0.001). Kaplan Meier with log-rank test analysis revealed improved overall survival (OS) comparing &[Prime]preNAC&[Prime] to &[Prime]NAC&[Prime] eras with 5 and 10 year OS increased from 35.7% to 50.6% and 23% to 40.4% respectively (p < 0.001).
Conclusions: The increased utilization of neoadjuvant chemotherapy at our institution for patients with cT2+ bladder cancer appears to have improved overall survival and complete response rates.