1747 PROGNOSTIC SIGNIFICANCE OF CYSTOSCOPY FINDINGS FOLLOWING NEOADJUVANT CHEMOTHERAPY FOR...
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with cT2, Caucasians (vs. African Americans) were more likely to be ineligible (43% vs. 15%; p0.0087, Fisher’s exact test). When evaluated by gender, females trended more likely to be ineligible than males (48% vs. 36%) although this did not reach statistical significance (p0.16, Fisher’s exact test). Older patients (70y) were nearly twice as likely to be ineligible as younger patients (70y) (53% v 29%; p0.0008, Fisher’s exact test). CONCLUSIONS: Our single-institution retrospective study shows that 40% of cT2 patients that receive radical cystectomy for muscle invasive disease are ineligible for cisplatin-based neoadjuvant chemotherapy based on their pre-operative renal function and that older patients and Caucasian patients are more likely to be ineligible than their younger and African American counterparts. New non-neph- rotoxic neoadjuvant chemotherapeutic regimens are needed to ensure that these patients receive chemotherapy before the progression of any micrometastases past the curable state. Source of Funding: Lineberger Comprehensive Cancer Center at The University of North Carolina at Chapel Hill 1747 PROGNOSTIC SIGNIFICANCE OF CYSTOSCOPY FINDINGS FOLLOWING NEOADJUVANT CHEMOTHERAPY FOR MUSCLE- INVASIVE BLADDER CANCER Ahmed M. Mansour*, Rakesh Singal, Ahmed Eldefrawy, Shivam Joshi, Mark S Soloway, Murugesan Manoharan, Miami, FL INTRODUCTION AND OBJECTIVES: We sought to evaluate the potential significance of cystoscopy findings following neoadjuvant chemotherapy (NAC) as prognostic indicator in patients undergoing radical cystectomy for muscle-invasive bladder cancer (MIBC). METHODS: We analyzed our prospectively maintained data- base for patients who received neoadjuvant chmeotherapy (NAC) prior to radical cystectomy for MIBC. Patients were divided into two groups according to cystoscopy performed after 2 cycles of NAC; Respondents (patients who had no evidence of tumor or decreased tumor volume) and Non respondents (patients who had tumor volume progression). We investigated the prognostic significance of the cystoscopy findings and its correlation with the final pathological and survival outcomes. Univariate analysis with the Pearson chi-square was done to analyze associations between observed response to chemotherapy on follow up cystoscopy (in respondents group) and pT stage, pT downgrading (pathological response) and pN stage (N0 and greater than N0). A Kaplan-Meier estimator curve with the log rank test and a Cox propor- tional hazard model were used to test whether observed response to chemotherapy predicted overall survival. RESULTS: Of 101 patients 60 (59%) patients were identified as respondents to NAC. There was no significant difference in patient demographics between the 2 groups. Univariate analysis showed sta- tistically significant association between response to chemotherapy observed on cystoscopy and pTstage, T stage downgrading and pN stage (each 0.001). In the respondents group 16 patients (26%) had pT0 in the final pathology. Furthermore, multivariate regression modeling revealed that non-response to NAC was an independent predictor of Node positive disease. There was a distinct survival benefit in NAC respondent group (p 0.001). On multivariate analysis, observed cystoscopic response to NAC was an independent predictor of survival in patients with MIBC (p 0.001), HR 0.298 (0.162- 0.549). CONCLUSIONS: Observed response to NAC on follow up cystoscopy is associated with favourable pathological outcomes and is a significant predictor of overall survival in patients undergoing radical cystectomy for MIBC. This correlation may have implications for pre- operative patient counseling and should be incorporated in prognostic nomograms. Source of Funding: None 1748 BLADDER CANCER PREDICTIVE NOMOGRAM FOR OVERALL SURVIVAL FOLLOWING RADICAL CYSTECTOMY Ahmed Abd El Latif*, Steven Campbell, Michael C. Gong, Tianming Gao, Michael W. Kattan, Amr Fergany, Cleveland, OH INTRODUCTION AND OBJECTIVES: Nomograms provide in- dividualized risk predictions for patients as opposed to staging-based group risk predictions. The goal of the present study is to build a prediction model for bladder cancer patient survival after radical cys- tectomy (RC). METHODS: From 2004 until 2008 we retrospectively identified 482 patients who underwent RC for urothelial carcinoma of the bladder (UBC). The pool of predictors identified includes: age at RC, gender, time between diagnosis and RC, smoking, American Society of Anesthe- sia (ASA) Score, chemotherapy (neoadjuvant, adjuvant), initial treatment 3 categories (RC or intravesical BCG or intravesical chemotherapy), path T, path N, surgical margins (SM), lymphovascular invasion (LVI), lymph node density (LND percentage of positive to total LN), path carci- noma in situ (CIS), total LN, total positive LN, LN dissection Type (standard or extended), path subtypes. We compared models with different predictors from a pool of predictors of interest by their predic- tion performance, and then chose the model with the highest concor- dance index (the best prediction performance). Restricted cubic splines were used for all continuous predictors to account for possible non- linear effect of the predictors. RESULTS: The outcome is all-cause mortality after RC for urothe- lial carcinoma of the bladder (UBC). The final model with the highest concordance index includes: age at RC, smoking, initial treatment 3 categories, path T, pathology subtypes, SM, LND, LVI. This was internally validated by bootstrap and cross-validation. The concordance index of the final model is 0.74. The nomogram for the final model is shown in (FIG1). CONCLUSIONS: We believe that this nomogram is the first to use initial treatment and pathological subtypes. They had substantial effects on the survival of patients with UBC who underwent RC. External validation of the nomogram would be helpful. Source of Funding: None Vol. 187, No. 4S, Supplement, Tuesday, May 22, 2012 THE JOURNAL OF UROLOGY e705
Transcript of 1747 PROGNOSTIC SIGNIFICANCE OF CYSTOSCOPY FINDINGS FOLLOWING NEOADJUVANT CHEMOTHERAPY FOR...
with �� cT2, Caucasians (vs. African Americans) were more likely tobe ineligible (43% vs. 15%; p�0.0087, Fisher’s exact test). Whenevaluated by gender, females trended more likely to be ineligible thanmales (48% vs. 36%) although this did not reach statistical significance(p�0.16, Fisher’s exact test). Older patients (�70y) were nearly twiceas likely to be ineligible as younger patients (�70y) (53% v 29%;p�0.0008, Fisher’s exact test).
CONCLUSIONS: Our single-institution retrospective studyshows that 40% of �� cT2 patients that receive radical cystectomy formuscle invasive disease are ineligible for cisplatin-based neoadjuvantchemotherapy based on their pre-operative renal function and thatolder patients and Caucasian patients are more likely to be ineligiblethan their younger and African American counterparts. New non-neph-rotoxic neoadjuvant chemotherapeutic regimens are needed to ensurethat these patients receive chemotherapy before the progression of anymicrometastases past the curable state.
Source of Funding: Lineberger Comprehensive CancerCenter at The University of North Carolina at Chapel Hill
1747PROGNOSTIC SIGNIFICANCE OF CYSTOSCOPY FINDINGSFOLLOWING NEOADJUVANT CHEMOTHERAPY FOR MUSCLE-INVASIVE BLADDER CANCER
Ahmed M. Mansour*, Rakesh Singal, Ahmed Eldefrawy, ShivamJoshi, Mark S Soloway, Murugesan Manoharan, Miami, FL
INTRODUCTION AND OBJECTIVES: We sought to evaluatethe potential significance of cystoscopy findings following neoadjuvantchemotherapy (NAC) as prognostic indicator in patients undergoingradical cystectomy for muscle-invasive bladder cancer (MIBC).
METHODS: We analyzed our prospectively maintained data-base for patients who received neoadjuvant chmeotherapy (NAC) priorto radical cystectomy for MIBC. Patients were divided into two groupsaccording to cystoscopy performed after 2 cycles of NAC; Respondents(patients who had no evidence of tumor or decreased tumor volume)and Non respondents (patients who had tumor volume progression).We investigated the prognostic significance of the cystoscopy findingsand its correlation with the final pathological and survival outcomes.Univariate analysis with the Pearson chi-square was done to analyzeassociations between observed response to chemotherapy on followup cystoscopy (in respondents group) and pT stage, pT downgrading(pathological response) and pN stage (N0 and greater than N0). AKaplan-Meier estimator curve with the log rank test and a Cox propor-tional hazard model were used to test whether observed response tochemotherapy predicted overall survival.
RESULTS: Of 101 patients 60 (59%) patients were identified asrespondents to NAC. There was no significant difference in patientdemographics between the 2 groups. Univariate analysis showed sta-tistically significant association between response to chemotherapyobserved on cystoscopy and pTstage, T stage downgrading and pNstage (each �0.001).
In the respondents group 16 patients (26%) had pT0 in the finalpathology. Furthermore, multivariate regression modeling revealed thatnon-response to NAC was an independent predictor of Node positivedisease. There was a distinct survival benefit in NAC respondent group(p � 0.001). On multivariate analysis, observed cystoscopic responseto NAC was an independent predictor of survival in patients with MIBC(p � 0.001), HR 0.298 (0.162- 0.549).
CONCLUSIONS: Observed response to NAC on follow upcystoscopy is associated with favourable pathological outcomes and isa significant predictor of overall survival in patients undergoing radicalcystectomy for MIBC. This correlation may have implications for pre-operative patient counseling and should be incorporated in prognosticnomograms.
Source of Funding: None
1748BLADDER CANCER PREDICTIVE NOMOGRAM FOR OVERALLSURVIVAL FOLLOWING RADICAL CYSTECTOMY
Ahmed Abd El Latif*, Steven Campbell, Michael C. Gong,Tianming Gao, Michael W. Kattan, Amr Fergany, Cleveland, OH
INTRODUCTION AND OBJECTIVES: Nomograms provide in-dividualized risk predictions for patients as opposed to staging-basedgroup risk predictions. The goal of the present study is to build aprediction model for bladder cancer patient survival after radical cys-tectomy (RC).
METHODS: From 2004 until 2008 we retrospectively identified482 patients who underwent RC for urothelial carcinoma of the bladder(UBC). The pool of predictors identified includes: age at RC, gender,time between diagnosis and RC, smoking, American Society of Anesthe-sia (ASA) Score, chemotherapy (neoadjuvant, adjuvant), initial treatment 3categories (RC or intravesical BCG or intravesical chemotherapy), path T,path N, surgical margins (SM), lymphovascular invasion (LVI), lymphnode density (LND � percentage of positive to total LN), path carci-noma in situ (CIS), total LN, total positive LN, LN dissection Type(standard or extended), path subtypes. We compared models withdifferent predictors from a pool of predictors of interest by their predic-tion performance, and then chose the model with the highest concor-dance index (the best prediction performance). Restricted cubic splineswere used for all continuous predictors to account for possible non-linear effect of the predictors.
RESULTS: The outcome is all-cause mortality after RC for urothe-lial carcinoma of the bladder (UBC). The final model with the highestconcordance index includes: age at RC, smoking, initial treatment 3categories, path T, pathology subtypes, SM, LND, LVI. This was internallyvalidated by bootstrap and cross-validation. The concordance index of thefinal model is 0.74. The nomogram for the final model is shown in (FIG1).
CONCLUSIONS: We believe that this nomogram is the first touse initial treatment and pathological subtypes. They had substantialeffects on the survival of patients with UBC who underwent RC.External validation of the nomogram would be helpful.
Source of Funding: None
Vol. 187, No. 4S, Supplement, Tuesday, May 22, 2012 THE JOURNAL OF UROLOGY� e705
