Presentation Authors: Nima Almassi*, Eugene Cha, Emily Vertosick, Chun Huang, Nathan Wong, Shawn Dason, Victor McPherson, Lucas Dean, Nicole Benfante, Daniel Sjoberg, Dean Bajorin, Jonathan Rosenberg, Guido Dalbagni, Andrew Vickers, Bernard Bochner, New York, NY
Introduction: Although recent epidemiologic studies have shown improved oncologic outcomes over time for patients with localized bladder cancer, a large single-center radical cystectomy (RC) series failed to demonstrate improved outcomes over a three-decade experience. Given this conflicting evidence, we sought to assess for changes in survival outcomes, perioperative management, and surgical performance at Memorial Sloan Kettering Cancer Center (MSKCC) over a 21-year period.
Methods: All patients with urothelial carcinoma who underwent RC at MSKCC from 1995 through 2015 were identified. Analysis of clinicodemographic changes over time was performed. Multivariable models adjusting for age, consensus tumor stage, lymph node (LN) status, and date of RC were generated. Adjusted rates of neoadjuvant chemotherapy (NAC) use and surgical performance including positive soft tissue and urothelial margins, total LN yield, pathologic T0 (pT0) rates, and 5-year rates of disease recurrence and cancer-specific death controlled for consensus stage are reported over time. Estimated rates with 95% confidence intervals (CI) are reported.
Results: The cohort includes 2,911 patients with a median 5.7-year follow-up (quartiles 3.5, 9.9). The distribution of age at RC (median 68 years; quartiles 61, 75) and gender (77% male) showed no significant changes over time (p=0.14 and p=0.3, respectively). NAC use among patients with muscle-invasive bladder cancer (MIBC) increased from < 6% before 2000 to 52% in 2015 (p < 0.001), with a corresponding rise in pT0 rates among patients with MIBC from 5.5% (95% CI 2.4%, 12%) in 1995 to 26% (95% CI 18%, 37%) by 2015 (p < 0.001). Mean LN yield increased from a mean of 7 LNs in 1995 to 25 in 2015 (p < 0.001). Positive soft tissue and urothelial margin rates decreased from 5% and 15% to < 1% and 9%, respectively, from 1995 to 2015 (p < 0.001, p=0.14). The adjusted probability of disease recurrence at 5 years decreased from 42% (95% CI 35%, 49%) in 1995 to 30% (95% CI 24%, 35%) in 2015 (p < 0.001). The adjusted probability of cancer-specific death at 5 years decreased from 33% (95% CI 26%, 39%) in 1995 to 20% (95% CI 15%, 25%) in 2015 (p < 0.001).
Conclusions: Over a 21-year span, we observed improved oncologic outcomes coinciding with increasing LN yield, negative soft tissue margin rates, use of NAC and pT0 rates, suggesting improvements in perioperative management and surgical performance have resulted in improved oncologic outcomes among patients undergoing RC.
Source of Funding: This work was supported by the Sidney Kimmel Center for Prostate and Urologic Cancers, the Michael and Zena Wiener for Therapeutics Program in Bladder Cancer, Pin Down Bladder Cancer, Cycle for Survival, NIH/NCATS Grant Number UL1-TR002384, and the Nation