PD14-08: Comparative outcomes of primary and recurrent high grade non-muscle invasive and primary and progressive muscle-invasive bladder cancer after radical cystectomy: results from a retrospective multicenter study

Nico Grossmann*, Lucerne, Switzerland, Benjamin Pradere, Frederik König, Pawel Rajwa, Fahad Quhal, Hadi Mostafaei, Ekaterina Laukhtina, Keiichiro Mori, Reza Motlagh, Satoshi Katayama, Vienna, Austria, Christian Fankhauser, Zurich, Switzerland, Agostino Mattei, Lucerne, Switzerland, Marco Moschini, Milan, Italy, Piotr Chlosta, Krakow, Poland, Bas van Rhijn, Amsterdam, Netherlands, Jeremy Teoh, Hong Kong, China, People's Republic of, Eva Compérat, Vienna, Austria, Marek Babjuk, Prague, Czech Republic, Mohammad Abufaraj, Amman, Jordan, Pierre Karakiewicz, Montreal, Canada, Shahrokh Shariat, Vienna, Austria

Introduction: We aimed to compare oncological outcomes between patients with primary high-risk non-muscle-invasive bladder cancer (primHR-NMIBC), recurrent HR-NMIBC (recHR-NMIBC), primary muscle-invasive bladder cancer (primMIBC) and progressive MIBC (progMIBC) after radical cystectomy (RC).

Methods: This study included 908 patients treated with RC without neoadjuvant chemotherapy (NAC) for clinically non-metastatic bladder cancer (BC). Primary HR-NMIBC and primMIBC are defined as no prior history of BC, whereas recHR-NMIBC and progMIBC are defined as previous treated NMIBC that recurred or progressed to MIBC despite intravesical therapy. Uni- and multivariable logistic and Cox regression analyses were used to identify predictors for pathologic features and survival outcomes; log-rank analyses were used to compare survival outcomes.

Results: Overall, 211 (23%) had primHR-NMIBC, 125 (14%) had recHR-NMIBC, 404 (44%) had primMIBC and 168 (19%) had progMIBC. Patients with progMIBC experienced more often lymph node involvement (LNI; 48% vs 12% primHR-NMIBC, 22% recHR-NMIBC, 27% primMIBC; p < 0.001) and pathological upstaging (69% vs. 47% primHR-NMIBC, 64% recHR-NMIBC, 51% primMIBC; p < 0.001). Recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS) were the lowest in progMIBC (41%, 47% and 39%, respectively) and were different compared to the other groups (p < 0.001 for all). Recurrent HR-NMIBC and primMIBC showed similar RFS, CSS and OS (60% vs. 61%; p = 0.8, 59% vs. 65%; p = 0.7 and 49% vs. 55%; p > 0.9, respectively).

On multivariable logistic regression, primMIBC (OR 1.85; p = 0.02) and progMIBC (OR 3.55; p < 0.001) were predictors for LNI and recHR-NMIBC for pathological upstaging (OR 2.01; p = 0.005). On multivariable Cox regression, recHR-NMIBC was associated with worse RFS (HR 1.66; p = 0.02), CSS (HR 1.82; p = 0.01) and OS (HR 1.47; p = 0.02) while progMIBC was associated with worse CSS (HR 1.78; p = 0.01) and OS (HR 1.57; p = 0.006).

Conclusions: We showed that recHR-NMIBC and primMIBC had similar oncological outcomes. Moreover, patients with progMIBC had the worst survival outcomes. Recurrent HR-NMIBC and progMIBC were independent risk factors for worse survival outcomes, suggesting a more aggressive tumor biology compared to primary tumors (NMIBC and MIBC). Thus, improved risk stratification at the NMIBC stage using biomarkers or improved imaging is desirable, to select those who would benefit from early RC or neoadjuvant systemic therapies.

Source of Funding: none