Presentation Authors: Emina Kayama*, Eiji Kikuchi, Kyohei Hakozaki, Nobuyuki Tanaka, Tokyo, Japan, Gou Kaneko, Suguru Shirotake, Saitama, Japan, Yasumasa Miyazaki, Kanagawa, Japan, Shunsuke Yokomine, Saitama, Japan, Takahiro Maeda, Kanagawa, Japan, Kunimitsu Kanai, Masafumi Oyama, Saitama, Japan, Yosuke Nakajima, Satoshi Hara, Kanagawa, Japan, Tetsuo Monma, Saitama, Japan, Mototsugu Oya, Tokyo, Japan
Introduction: We conducted a retrospective study to examine whether a history of non-muscle invasive bladder cancer (NMIBC) plays a prognostic role in radical cystectomy (RC)-treated patients with cT2-T4a muscle invasive bladder cancer (MIBC) without lymph node involvement. We also evaluated whether neoadjuvant chemotherapy may be equally effective in initially diagnosed MIBC patients without a history of NMIBC (i.e. primary MIBC) and those that progressed from NMIBC (i.e. progressive MIBC).
Methods: We identified a total of 282 patients who were diagnosed as cT2-T4aN0M0 bladder cancers, treated with open RC and were having no lymph node involvement at our institutions between 2004 and 2015. We compared the clinic-pathological characteristics and clinical outcome according to the type of MIBC (primary MIBC, N=231 vs progressive MIBC, N=51).
Results: The primary MIBC group had 48.1% of patients in cT2, 40.7% in cT3, and 11.3% in cT4, while the progressive MIBC group had 72.5% in cT2, 17.6% in cT3, and 9.8% in cT4 (p=0.004). In overall, the 5-year cancer-specific survival (CSS) rate in progressive MIBC group was 61.6%, which was significantly lower than that in primary MIBC group (76.1%, p=0.005, figure below). Progressive MIBC (Hazard Ratio; HR of 2.170, p=0.008) was independently associated with cancer death. In primary MIBC group, the 5-year CSS rate in patients treated with neoadjuvant chemotherapy was 85.4%, which was significantly higher than those without (71.5%, p=0.023) and multivariate Cox&[prime]s regression analysis revealed that pathological T3 or more, LN dissected of ≤ 8, and LVI positivity were independently associated with cancer death. In progressive MIBC group, no significantly difference on CSS was observed between patients treated with and without neoadjuvant chemotherapy and pathological T3 or more and a positive surgical margin were independently associated with cancer death.
Conclusions: MIBC progressed from NMIBC had significantly worse clinical outcome as compared to MIBC without a history of NMIBC and might have less efficacy for neoadjuvant chemotherapy. These results would be informative even for NMIBC patients treated with conservative intravesical therapy.