NMIBC: RC before progression yields superior survival outcomes

  • Soria F & al.
  • World J Urol
  • 31 Aug 2018

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • Patients with high-grade nonmuscle-invasive bladder cancer (NMIBC) treated with radical cystectomy (RC) before experiencing progression show superior survival vs those who progressed before or at RC.
  • Tumor size and concomitant carcinoma in situ (CIS) at diagnosis were independent predictors of RC.

Why this matters

  • Identifying predictive factors of RC can help select patients for early RC.

Study design

  • Study of 2451 patients with high-grade NMIBC initially treated with Bacillus Calmette-Guerin (BCG).
  • Funding: None.

Key results

  • 20.8% of patients underwent RC.
  • Patients with tumors ≥3 cm or CIS had earlier RC (HR, 1.75 and 1.64, respectively; both P<.001>
  • Patients undergoing RC before progression showed superior survival vs those who progressed before or at RC (82% vs 47% and 60%, respectively; P<.001>
  • In patients who progressed either before or at surgery (n=337), timing of RC was not associated with risk for progression at RC (HR, 1.19; P=.27).
  • Patients with tumors ≥3 cm or multiple tumors (HR, 1.71 [P=.002] and 1.79 [P=.001], respectively) and those with tumors ≥3 cm or concomitant CIS (HR, 1.79 [P=.001] and 1.53 [P=.02], respectively) had earlier T3/T4 or N+ cystectomies.
  • Patients with T3/T4 or N+ disease or CIS at cystectomy had shorter disease-specific survival (HR, 4.38 and 2.39; both P<.001>

Limitations

  • Retrospective design.

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