CLO20-055: Optimal Timing of Radical Surgery From Diagnosis in Muscle Invasive Bladder Cancer (MIBC)

Background: Non-metastatic muscle invasive bladder cancer (MIBC) is treated with radical cystectomy and survival is closely associated with final pathologic staging. For patients undergoing primary surgery there is evidence that delay > 90 days after diagnosis adversely effects survival outcomes. Neoadjuvant chemotherapy (NAC) has become the standard of care for appropriate patients, which delays definitive surgery. Optimal timing of surgery from the time of diagnosis is uncertain when done after NAC. We studied this question using National Cancer Database (2004-2015). Methods: We identified patients > 18 years with MIBC (cT2-T4aN0M0 & cT1-T4aN1M0). All patient’s received NAC within 6 months of diagnosis and underwent surgery within 9 months of the start of NAC. We excluded patients who died within 30 days of surgery. Time from diagnosis to surgery was stratified into five cohorts; <18, 19-22, 23-26, 27-30, and >31 weeks. Descriptive analysis, Kaplan-Meier plots, Log-Rank tests for univariate and proportional hazards models for multivariate survival analyses were performed. Results: 4168 patients were identified; 75% were males, 70% cases were stage 2, and 73% had charlson-deyo score (CS) of 0. Median time to surgery from diagnosis was 154 days. Majority (60%) were treated at academic and 24% at comprehensive community. Only 28% achieved complete pathological complete response rate (Tis or T0). On univariate analysis patients receiving surgery within 30 weeks of diagnosis had significantly better survival (p<0.05). Receiving chemotherapy within 3 months of diagnosis was significantly associated with survival benefit on univariate analysis (p<0.05) which was not present on multivariate analysis HR 0.99 (0.82-1.20). In addition patients with CS of ‘1’ and age > 75 had significantly worse survival with HR 1.15 (1.02-1.28) and 1.63(1.28-2.09). Achieving less than pathological complete response defined as (pTis, pT0, pTa) was associated with significantly poor survival (p<0.0001) Conclusions: Our study shows that appropriate patients with MIBC benefit from receiving surgery within 30 weeks of diagnosis.

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Corresponding Author: Saurabh Parasramka, MD
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