Introduction:
The COVID-19 pandemic brought unprecedented changes to urologic care in order to minimize risks of transmission. CxBladder Monitor (CxM) is a urine test which quantifies mRNA levels of five cancer biomarkers to "rule out" urothelial carcinoma with a reported sensitivity between 91 to 95% and NPV of 96 to 97%. At UCSF, we performed a prospective pilot study of the CxM test to inform the urgency of surveillance cystoscopy in patients with non-muscle invasive bladder cancer (NMIBC).
Methods:
From March-June 2020, patients with NMIBC due for surveillance cystoscopy were offered CxM prior to scheduling a clinic visit. Based on prior studies, a CxM score ≥3.5 was used to proceed with cystoscopy while a score below that threshold led to deferring (negative predictive value 97%) cystoscopy. Patients offered CxM were surveyed about ease, affordability, and acceptability of the test. Clinical outcomes of interest included whether in-office cystoscopy was deferred or performed based on CxM and detection of urothelial cancer at immediate or next surveillance cystoscopy.
Results:
52 patients (73% men) with median age 71 (IQR 65-78) years and 4.0 (IQR 2.5-6.1) years since initial cancer diagnosis were included. By AUA risk stratification, 14 (27%), 17 (33%), and 20 (41%) were low, intermediate, and high-risk.
Patients with CxM ≥3.5 (17/52, 33%) were more likely to have high-grade disease at diagnosis (78% vs 64%) but did not differ by age, gender, race, history of UTUC, T stage, or prior recurrences versus patients with CxM <3.5. 14/17 patients (82%) underwent immediate cystoscopy. 7 (50%) had findings on cystoscopy necessitating biopsy (2 CIS, 2 HG Ta, 2 T2, 1 UTUC).
35 patients with CxM scores < 3.5 deferred cystoscopy to next surveillance (63% 3 months, 34% 6 months, or 3% 9 months). 32 (91%) patients have since undergone surveillance cystoscopy (median 4.0 months after) with no suspicious tumor or cytology detected.
37/52 patients responded to the survey (Table 1).
Conclusion:
CxM was feasible and safe for patients on surveillance for NMIBC and decreased frequency of cystoscopy. CxM may be used to further risk stratify patients to deintensify surveillance for NMIBC during the COVID-19 pandemic and beyond. Additional study of patient ease and acceptability is ongoing.
Funding: N/A
Image(s) (click to enlarge):
USE OF CXBLADDER MONITOR DURING THE COVID-19 PANDEMIC TO REDUCE THE FREQUENCY OF SURVEILLANCE CYSTOSCOPY
Category
Bladder Cancer > Non-Muscle Invasive Bladder Cancer
Description
Poster #84
Thursday, Dec 2
10:00 a.m. - 11:00 a.m.
Bladder 4
Presented By: Kevin Danis Li
Authors:
Kevin D. Li
Carissa C. Chu
Maxwell V. Meng
Sima P. Porten