UP-36 The prognostic value of urinary cytology after trimodal therapy for muscle-invasive bladder cancer
Thursday June 27, 2019 from
TBD
Presenter

Sophie O'Halloran, Canada

Research Trainee

Department of Surgical Oncology (Urology)

University Health Network

Abstract

The prognostic value of urinary cytology after trimodal therapy for muscle-invasive bladder cancer

Louise McLoughlin1, Sophie O'Halloran1, Michael Tjong2, Khaled Ajib1, Katherine Lajkosz1, Peter Chung2, Neil E. Fleshner1, Alejandro Berlin2.

1Department of Surgical Oncology (Urology), University Health Network, Toronto, ON, Canada; 2Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada

Introduction: Complete response after trimodal therapy (TMT) for muscle-invasive bladder cancer (MIBC) includes a negative urine cytology (NC), no visible tumor and negative biopsies. The significance of positive urinary cytology (PC) post TMT (pTMT) without lesions in the upper tract, or intravesical clinical/pathological recurrence is unknown. Altered cytology pTMT may represent recurrence, treatment effects, or a marker of de-novo urothelial lesions. Rates and temporal trends of PC pTMT were analyzed to determine its potential use as a prognostic marker for bladder cancer recurrence pTMT.

Methods: This is a retrospective study of 150 patients who had TMT for MIBC at a single academic institution between 2002-2017. Available cytology results (NC vs PC/equivocal) pTMT were evaluated for association with recurrence free survival (RFS)(n=128). Time-to-recurrence, stratified by first cytology pTMT, and time-to-NC were assessed by the Kaplan Meier method. Differences between groups were evaluated with the log rank test.

Results: We observed 61 recurrences in 128 patients with a median follow up of 3.6 years (range 0.3-14.2), (13[21%] local, 11[18%] urinary tract, 13[21%] metastasis, 24[39%] other). PC pTMT occurred in 41(32%) patients at first follow-up; NC occurred in 115(90%) patients at any point. Median RFS was shorter with PC vs NC at first follow up pTMT (21.3 vs 78.1 months, p=0.047), with an increase in cumulative recurrence rate at 3.3 years (PC n=24(60%) vs NC n=37(42%), p=0.085). Persistence of PC (≥4 months pTMT, n=33, 22%) had a median time-to-NC of 3.22 months (95% CI: 2.99-5.80). Longer time-to-NC was associated with recurrence (3.68 months [95% CI: 3.22-8.96] vs 2.76 months [95% CI: 0.69-2.99]).

Conclusion: NC post TMT and shorter interval to NC is associated with improved RFS and potentially lower rates of recurrence. Defining the role of cytology post TMT is warranted as an available and inexpensive biomarker to guide survivorship and salvage protocols.


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