PD44-09: IMPACT OF HIGH-RISK FEATURES AND STAGING ON NEOADJUVANT CHEMOTHERAPY AMONG PATIENTS TREATED WITH RADICAL CYSTECTOMY: A SINGLE CENTER ANALYSIS OF 1700 CASES
Introduction: Neoadjuvant chemotherapy (NAC) followed by radical cystectomy with pelvic lymph node dissection (RC) has convincingly demonstrated improvement in survival and consequently been established as the new standard-of-care for muscle invasive bladder cancer (MIBC). Due to its toxicity, multi-agent platinum-based chemotherapy has been variably adopted in the neoadjuvant setting. In this study, we report the long-term outcomes from our institutional experience with the use of NAC in MIBC patients Methods: 1700 patients who underwent RC at Moffitt Cancer Center between July 2004 and October 2020 for bladder cancer were retrospectively reviewed. Patients received presurgical chemotherapy and radical cystectomy (PC) or underwent upfront radical cystectomy with no chemotherapy (NC). cT2 patients were sub-stratified as high-risk (HR) or low-risk (LR) using the MDACC risk criteria including the presence of hydronephrosis, LVI, prostatic urethral involvement, and variant histology. Results: 761 PC and 805 NC patients were retrospectively identified with complete baseline information. Amongst 461 NC patients with =cT2 disease, 118 (25%) achieved pathologic downstaging Conclusions: Pathologic response rates to PC were modest compared to those previously reported in randomized controlled trials and only cT2 patients derived OS benefit among those that received PC. Upon further analysis it was found that following stratification using the MDACC risk criteria, only HR cT2 patients obtained a benefit from presurgical chemotherapy. SOURCE OF Funding: None
