MP-04.19 Inter-Observer Variation in the Pathological Diagnosis of Non-Muscle Invasive Bladder Cancer Between Tertiary Care Centers and Central Pathology Review

e16033 Background: Although the use of Neoadjuvant Chemotherapy (NAC) has now become the standard of care for Muscle Invasive Bladder Cancer (MIBC) in the world, most patients in lower- middle-income countries (LMIC), like Pakistan, are still undergoing upfront surgery despite being ideal candidates for chemotherapy. Multi-disciplinary tumor boards have been critical in the change of this trend in the developed world. We aimed to assess the trends in the use of NAC for patients with muscle invasive bladder cancer before undergoing definitive surgery. Methods: We included patients who underwent surgery for ≥ cT2 MIBC without distant metastasis between 2011 and 2015 at a tertiary care hospital in Karachi, Pakistan. We retrospectively assessed the trends in NAC compared to upfront surgery in these patients. Results: Among the 171 patients included in our study, only 4 (2.34%) received NAC, whereas the other 167 (97.67%) underwent upfront surgery without NAC. Out of the 90 patients who underwent surgery for MIBC between 2011 and 2013, none of them received NAC and underwent upfront surgery. Among the 81 patients with MIBC in 2014 and 2015, 4 patients received NAC before surgery whereas the other 77 underwent upfront surgery. Conclusions: The adoption of NAC for MIBC remains a challenge in lower- middle-income countries such as Pakistan. Introduction of a multidisciplinary tumor board in our hospital since 2014 has shown a slight change in this trend. Better communication between different departments remains the key in significantly changing the trend of a much desired standard of care.

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51 MOLECULAR MARKERS SHOW DIFFERENCES IN BIOLOGICAL POTENTIAL PER GRADE CATEGORY FOR THE WHO 1973 AND 2004 CLASSIFICATION SYSTEMS: A LARGE MULTI-CENTER STUDY WITH CENTRAL PATHOLOGY REVIEW IN NON-MUSCLE INVASIVE BLADDER CANCER

European Urology Supplements ◽

10.1016/s1569-9056(10)60059-0 ◽

2010 ◽

Vol 9 (2) ◽

pp. 49

Author(s):

B.W.G. Van Rhijn ◽

M. Musquera ◽

A.N. Vis ◽

C.H. Bangma ◽

E.C. Zwarthoff ◽

...

Keyword(s):

Bladder Cancer ◽

Molecular Markers ◽

Classification Systems ◽

Muscle Invasive Bladder Cancer ◽

Biological Potential ◽

Central Pathology ◽

Muscle Invasive ◽

Multi Center Study ◽

Pathology Review ◽

Center Study

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1468 MOLECULAR MARKERS SHOW DIFFERENCES IN BIOLOGICAL POTENTIAL PER GRADE CATEGORY FOR THE WHO 1973 AND 2004 CLASSIFICATION SYSTEMS. A LARGE MULTI-CENTER STUDY WITH CENTRAL PATHOLOGY REVIEW IN NON-MUSCLE INVASIVE BLADDER CANCER

The Journal of Urology ◽

10.1016/j.juro.2010.02.1183 ◽

2010 ◽

Vol 183 (4S) ◽

Author(s):

Bas van Rhijn ◽

Mireia Musquera ◽

André Vis ◽

Chris Bangma ◽

Ellen Zwarthoff ◽

...

Keyword(s):

Bladder Cancer ◽

Molecular Markers ◽

Classification Systems ◽

Muscle Invasive Bladder Cancer ◽

Biological Potential ◽

Central Pathology ◽

Muscle Invasive ◽

Multi Center Study ◽

Pathology Review ◽

Center Study

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The incidence of prostate cancer and urothelial cancer in the prostate in cystoprostatectomy specimens in a tertiary care Canadian centre

Canadian Urological Association Journal ◽

10.5489/cuaj.212 ◽

2013 ◽

Vol 7 (1-2) ◽

pp. 35 ◽

Cited By ~ 5

Author(s):

Sri Sivalingam ◽

Darrel Drachenberg

Keyword(s):

Prostate Cancer ◽

Bladder Cancer ◽

Urothelial Cancer ◽

Tertiary Care ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Radical Cystoprostatectomy ◽

Functional Benefit ◽

Clinically Significant ◽

Muscle Invasive

Introduction: Radical cystoprostatectomy remains the gold standard treatment for muscle invasive bladder cancer. However, given the treatment related complications of compromised potency and continence with this procedure, prostate/sexuality sparing cystectomyin orthotopic neobladder candidates has emerged in an effort to minimize these quality of life concerns. Recent evidence suggests only a marginal functional benefit from these technical refinements. We sought to determine the incidence of occult prostate cancer and urothelial cancer of the prostate in cystoprostatectomy specimens conducted for muscle invasive bladder cancer.Methods: We retrospectively reviewed 83 male patients who underwent radical cystoprostatectomy for muscle invasive bladder cancer between April 2004 and March 2007. The median age ofour study group was 71 years. Pathologic findings of prostate/urothelia lcancer in the prostate were identified. Clinically significant prostate cancer was defined as Gleason score >6, tumour volume >0.5cc, extracapsular extension or perineural invasion.Results: Our review yielded a 30% (±10%, 0.95 CI) rate of prostate cancer, with 19% (± 8.5%, 0.95 CI) of total specimens being positive for clinically significant prostate cancer. Urothelial cancer in the prostate was identified in 16% (±8.5%, 0.95 CI) of patients, with an overlap with prostate cancer in 2 patients. The overall rate of an underlying cancer within the prostate of our cystoprostatectomy specimens was about 46% (±10.7%, 0.95 CI).Conclusion: These findings suggest that the oncological risk of leaving behind residual cancer may not justify the practice of prostate sparing cystectomies.

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Delaying BCG immunotherapy onset after transurethral resection of non-muscle-invasive bladder cancer is associated with adverse survival outcomes

World Journal of Urology ◽

10.1007/s00345-020-03522-3 ◽

2020 ◽

Author(s):

Wojciech Krajewski ◽

◽

Marco Moschini ◽

Joanna Chorbińska ◽

Łukasz Nowak ◽

...

Keyword(s):

Bladder Cancer ◽

Transurethral Resection ◽

Change Point ◽

Tertiary Care ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Free Survival ◽

Bcg Immunotherapy ◽

Increased Risk ◽

Muscle Invasive

Abstract Purpose This study was carried out to assess whether a prolonged time between primary transurethral resection of non-muscle-invasive bladder cancer (TURB) and implementation of bacillus Calmette–Guerin (BCG) immunotherapy (time to BCG; TTBCG) is associated with adverse oncological survival in patients with T1 high-grade (HG) non-muscle-invasive bladder cancer (NMIBC). Materials and methods Data on 429 patients from 13 tertiary care centers with primary T1HG NMIBC treated with reTURB and maintenance BCG between 2001 and 2019 were retrospectively reviewed. Change-point regression was applied following Muggeo’s approach. The population was divided into subgroups according to TTBCG, whereas the recurrence-free survival (RFS) and progression-free survival (PFS) were estimated with log-rank tests. Additionally, Cox regression analyses were performed. Due to differences in baseline patient characteristics, propensity-score-matched analysis (PSM) and inverse-probability weighting (IPW) were implemented. Results The median TTBCG was 95 days (interquartile range (IQR): 71–127). The change-point regression analysis revealed a gradually increasing risk of recurrence with growing TTBCG. The risk of tumor progression gradually increased until a TTBCG of approximately 18 weeks. When the study population was divided into two subgroups (time intervals: ≤ 101 and > 101 days), statistically significant differences were found for both RFS (p = 0.029) and PFS (p = 0.005). Furthermore, in patients with a viable tumor at reTURB, there were no differences in RFS and PFS. After both PSM and IPW, statistically significant differences were found for both RFS and PFS, with worse results for longer TTBCG. Conclusion This study shows that delaying BCG immunotherapy after TURB of T1HG NMIBC is associated with an increased risk of tumor recurrence and progression.

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