Introduction:
Neoadjuvant cisplatin-based chemotherapy (NAC) followed by radical cystectomy is the standard of care for patients with muscle-invasive bladder cancer (MIBC) who have adequate renal function to receive cisplatin. However, 15-35% of such patients will present with hydronephrosis secondary to distal ureteral obstruction by the primary tumor. It is currently unknown whether relief of this obstruction prior to initiation of NAC is beneficial in asymptomatic patients with adequate renal function.
Methods:
We retrospectively reviewed an institutional database of patients undergoing NAC for MIBC. Patients with ureteral obstruction were identified and separated into relieved obstruction (RO) and unrelieved obstruction (URO) groups based on whether a percutaneous nephrostomy tube or nephroureteral stent was placed in the obstructed kidney(s) prior to NAC initiation. Outcomes of interest were grade ≥3 adverse events, premature NAC discontinuation, NAC dose reduction, and change in glomerular filtration rate (GFR) after NAC. Multivariate comparisons were performed using logistic and linear regression controlling for baseline GFR, baseline hemoglobin, and chemotherapy regimen. All imaging studies were manually reviewed, and two sensitivity analyses were performed excluding URO patients with only mild hydronephrosis, which was defined 1) subjectively on a mild/moderate/severe scale and 2) as an anterior-posterior renal pelvis diameter less than the 33rd percentile of kidneys in the data set in which a urinary drainage device was later placed.
Results:
280 patients underwent NAC of whom 48 were classified as RO and 37 were classified as URO. One URO patient underwent placement of a urinary drainage device after NAC initiation and was analyzed with this group. There were no statistically significant differences between the two groups in any baseline characteristic or outcome measure. (Table 1) Multivariate analysis similarly showed no difference between groups in any outcome (p=0.88, 0.87, and 0.52 for premature NAC discontinuation, grade >= 3 adverse events, and change in GFR respectively). 14 and 19 patients in the URO group had sufficient hydronephrosis to be included in the first and second sensitivity analyses respectively. Multivariate analyses for the same outcomes similarly showed no differences between the RO and URO groups in either sensitivity analysis (p= 0.87, 0.64, 0.26 and 0.44, 0.86, 0.24 respectively).
Conclusion:
Our data suggest that patients with ureteral obstruction and adequate renal function can safely avoid invasive procedures to relieve ureteral obstruction prior to receiving NAC for MIBC.
Funding: N/A
Image(s) (click to enlarge):
Is Relief of Ureteral Obstruction Prior to Initiation of Neoadjuvant Chemotherapy Beneficial for Muscle-Invasive Bladder Cancer Patients Who Are Already Eligible for Cisplatin?
Category
Bladder Cancer > Muscle Invasive Bladder Cancer
Description
Poster #12
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Presented By: Matthew Epstein
Authors:
Matthew Epstein
Marshall Strother
Elizabeth Handorf
Mengying Deng
Emily Bochner
Bianca Lewis
Fern Anari
David Y T Chen
Andres Correa
Pooja Ghatalia
Richard Greenberg
Marc Smaldone
Rosalia Viterbo
Matthew Zibelman
Robert Uzzo
Elizabeth Plimack
Daniel Geynisman
Alexander Kutikov