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Past Meetings

17th Annual Meeting of the Society of Urologic Oncology

November 30 - December 02, 2016
Program Chair: Brett S. Carver, MD
Please note speakers and times are subject to change
All sessions located in Texas DEF unless otherwise noted

DateTimeSession
OVERVIEW  
30
Wed
10:00 a.m.-6:00 p.m.
Registration/Information Desk Open
Location: Texas Foyer
30
Wed
10:00 a.m.-6:00 p.m.
Speaker Ready
Location: Crockett A
30
Wed
2:00 p.m.-6:00 p.m.
Exhibit Hall
Location: Texas A & Foyer
30
Wed
4:30 p.m.-6:00 p.m.
SUO CTC Board of Directors Meeting
Location: Crockett C/D
30
Wed
6:00 p.m.-9:00 p.m.
SUO Board of Directors Meeting
Location: Republic A/B
30
Wed
6:00 p.m.-9:00 p.m.
*Young Urologic Oncologists (Y.U.O Dinner)
Location: Texas B/C
GENERAL SESSION  
30
Wed
12:00 p.m. - 1:00 p.m.
Industry Sponsored Lunch Symposium
Location: Texas B
30
Wed
1:00 p.m. - 2:45 p.m.
Germline Genetics Session in Urologic Malignancies
Session Chair:
Ryan P. Kopp, MD
Portland VA Medical Center
Portland
30
Wed
1:00 p.m. - 1:15 p.m.
Germline Implications of Somatic Profiling
Speaker:
Mark E. Robson, MD
Memorial Sloan Kettering Cancer Center
New York
30
Wed
1:15 p.m. - 1:30 p.m.
Prostate SNPS; Clinical Applicability for Screening and Chemoprevention
Speaker:
Andrew K. Kader, MD, PhD
UCSD Moores Cancer Center
La Jolla
30
Wed
1:30 p.m. - 1:45 p.m.
Inherited DNA-Repair Gene Mutations in Men with Metastatic Prostate Cancer
Speaker:
Peter Nelson, MD
University of Washington
Seattle
30
Wed
1:45 p.m. - 2:00 p.m.
Clinical Implications for Prostate Cancer Screening and Treatment of Men with Germline Mutations in BRCA and other DNA Repair Genes
Speaker:
Heather H. Cheng, MD, PhD
University of Washington
Seattle
30
Wed
2:00 p.m. - 2:15 p.m.
Germline Susceptibility for Bladder Cancer
Speaker:
Jianfeng Xu, MD, PhD
NorthShore University HealthSystem
Evanston
30
Wed
2:15 p.m. - 2:30 p.m.
The Platinum Study: Clinical Translational Research in Testicular Cancer Survivors
Speaker:
Lois B. Travis, MD, ScD
Indiana University Melvin and Bren Simon Cancer Center
Indianapolis
30
Wed
2:30 p.m. - 2:45 p.m.
Q&A
30
Wed
2:45 p.m. - 3:15 p.m.
Break/Visit Exhibits
Location: Texas A & Foyer
30
Wed
3:15 p.m. - 4:45 p.m.
Partial Gland Ablation for Prostate Cancer
Moderators:
Ardeshir R. Rastinehad, DO, FACOS
Mount Sinai Urology
New York


Sven Wenske, MD
Columbia University
New York
Session Chair:
Jonathan Andrew Coleman, MD
Memorial Sloan Kettering Cancer Center
New York
30
Wed
3:15 p.m. - 3:18 p.m.
Introductory Remarks
Speaker:
Ardeshir R. Rastinehad, DO, FACOS
Mount Sinai Urology
New York
30
Wed
3:18 p.m. - 3:30 p.m.
Partial Gland Ablation and Focal Therapies: Current Consensus and the SUO
Speaker:
Scott E. Eggener, MD
University of Chicago Medical Center
Chicago
30
Wed
3:30 p.m. - 3:40 p.m.
Results of Clinical Trials in PGA therapies
Speaker:
Jonathan Andrew Coleman, MD
Memorial Sloan Kettering Cancer Center
New York
30
Wed
3:40 p.m. - 3:52 p.m.
Clinical Trial Development in PGA Therapies- What Will it Take?
Speaker:
Jonathan Andrew Coleman, MD
Memorial Sloan Kettering Cancer Center
New York
30
Wed
3:52 p.m. - 4:03 p.m.
Imaging and Focal Therapy: Reliable Enough?
Speaker:
Peter Anthony Pinto, MD
National Cancer Institute
Bethesda
30
Wed
4:03 p.m. - 4:14 p.m.
Addressing Patient Expectations
Speaker:
Behfar Ehdaie, MD MPH
Memorial Sloan-Kettering Cancer Center
New York
30
Wed
4:14 p.m. - 4:25 p.m.
In Pipeline Developments for Partial Gland Treatment
Speaker:
Badrinath R. Konety, MD, MBA
University of Minnesota
Minneapolis
30
Wed
4:25 p.m. - 4:45 p.m.
Panel Q&A led by Moderators
Moderator:
Ardeshir R. Rastinehad, DO, FACOS
Mount Sinai Urology
New York
Panelists:
Jonathan Andrew Coleman, MD
Memorial Sloan Kettering Cancer Center
New York


Scott E. Eggener, MD
University of Chicago Medical Center
Chicago


Behfar Ehdaie, MD MPH
Memorial Sloan-Kettering Cancer Center
New York


Badrinath R. Konety, MD, MBA
University of Minnesota
Minneapolis


Peter Anthony Pinto, MD
National Cancer Institute
Bethesda
30
Wed
4:30 p.m. - 6:15 p.m.
*Poster Session I and Reception
Location: Texas A & Foyer
30
Wed
Poster #1
USE OF ADJUVANT CHEMOTHERAPY IN PATIENTS WITH ADVANCED BLADDER CANCER AFTER NEOADJUVANT CHEMOTHERAPY
Wilson Sui ¹, Emerson Lim MD², Guarionex DeCastro MD¹, James McKiernan MD¹ and Christopher Anderson MD¹
¹Department of Urology, Columbia University Medical Center, New York, NY; ²Department of Medicine, Columbia University Medical Center, New York, NY
Presented by: Wilson Sui

Introduction: Patients with non-organ confined disease at radical cystectomy (RC) have a poor prognosis, especially after neoadjuvant chemotherapy (NAC). We hypothesized that use of adjuvant chemotherapy (AC) is associated with improved survival compared to observation along among patients with advanced disease at RC after NAC.

Materials and methods: Using the National Cancer Database, we identified patients who received NAC prior to RC and had advanced stage (pT3/4) or pathologically involved nodes (pN+) at the time of surgery from 2004-2013. We determined whether patients then received AC or were managed with observation only. We used multivariable proportional hazards regression to estimate the impact of AC on overall survival and performed a pre-specified subgroup analysis for pN+ patients only.

Results: Overall 46% (N=1,116) of patients who received NAC and underwent RC were pT3/4 and/or pN+. Of these patients, 23% (N=259) received subsequent chemotherapy and the rest were observed. Median survival for the entire cohort was 20 months (95% CI 19 – 22) and there was no survival advantage for the AC cohort on multivariate analysis. On sub-group analysis, pN+ patients who received AC showed a higher median survival compared to the observation cohort (22 months [95% CI 18 – 26] versus 17 months [95% CI 15 – 19]; p = 0.044). After adjusting for demographic and cancer characteristics, AC was associated with a decreased hazards of death (HR 0.68, 95% CI 0.49 – 0.97) compared to observation for pN+ patients.

Conclusions: Patients who are pT3/4 and/or pN+ after NAC and RC have a poor prognosis. The addition of AC in a subset of these patients may be beneficial. Further research should focus identifying patients who may benefit from additional chemotherapy.
30
Wed
Poster #2
LONG-TERM SURVIVAL OUTCOMES WITH INTRAVESICAL NANOPARTICLE ALBUMIN-BOUND PACLITAXEL FOR RECURRENT NONMUSCLE INVASIVE BLADDER CANCER AFTER PREVIOUS BACILLUS CALMETTE-GUÉRIN THERAPY
Dennis Robins MD, Wilson Sui , Justin T. Matulay MD, G. Joel DeCastro MD, Chrostopher B. Anderson MD and James M. McKiernan MD
Department of Urology, Columbia University Medical Center, New York, NY
Presented by: Dennis Robins

Introduction and Objectives: Response rates to salvage intravesical therapies for BCG-refractory non-muscle-invasive bladder cancer (NMIBC) range between 10 and 30%. We have previously reported the results of a phase II trial of intravesical nanoparticle albumin bound (nab)-paclitaxel, which demonstrated minimal toxicity and a 35.7% response rate. We now present an updated cohort with long-term follow-up.

Materials and Methods: This was an investigator initiated, single-center, single-arm, phase II trial investigating the use of intravesical nab-paclitaxel in patients with recurrent Tis, Ta, and T1 urothelial carcinoma who failed at least one prior induction course of intravesical bacillus Calmette-Guérain (BCG). Patients received 500mg/100ml of nab-paclitaxel administered as 6 weekly intravesical instillations. Six weeks after the final instillation, response was evaluated by cystoscopy with biopsy, cytology, and cross-sectional imaging and any positive element constituted a recurrence. All complete responders (CR) were started on full-dose monthly maintenance for 6 months. Overall survival (OS), recurrence-free survival (RFS), cystectomy-free survival (CFS), and cancer-specific survival (CSS) were described using Kaplan-Meier curves.

Results: A total of 28 patients were enrolled with a median age of 79 (interquartile range 73-85) and a median number of prior intravesical therapies of 2. The median follow-up was 41 months (interquartile range 21-61). Ten of the 28 (36%) patients achieved CR 6 weeks after their final nab-paclitaxel instillation. 6 out of 10 CR patients remained durable responders after a median of 33 months (interquartile range 21-45).

The estimated 5-year OS, RFS and CFS were 56%, 18%, and 54%, respectively. Radical cystectomy was performed in 11/28 (39.2%) patients, of which only 2/11 (18.1%) had pT2 or greater disease. Only 2 patients died of bladder cancer for a 5-year CSS of 91.3%.

Conclusions: Intravesical nab-paclitaxel achieved a 36% CR rate at 3 months as salvage therapy for patients with NMIBC and previous BCG failure. This response was durable for nearly one-fifth of patients, and over half of all patients avoided cystectomy at 5-years.

Disclosures/COI: None
Funding: None
30
Wed
Poster #3
REPEAT USE OF BLUE LIGHT CYSTOSCOPY WITH HEXAMINOLEVULINATE FOR PATIENTS WITH UROTHELIAL CELL CARCINOMA
Giulia Lane MD¹, Tracy Downs MD², Ayman Soubra MD³, Amrita Rao BS4, Lauren Hemsley MPH³, Christopher Laylan BS², Fangfang Shi MS² and Badrinath Konety MD, MBA³
¹Minneapolis; ²University of Wisconsin, Madison, WI; ³University of Minnesota, Minneapolis, MN; 4Medical College of Wisconsin, Milwaukee, WI
Presented by: Giulia Lane

Purpose: Hexaminolevulinate hydrochloride (HAL) with blue light cystoscopy (BLC) is approved by the U.S. Food and Drug Administration as an adjunct to white light cystoscopy (WLC) for the detection of urothelial cell carcinoma. In this study we examine the tolerability of the repeat use of WLC+BLC. Materials and Methods: We retrospectively reviewed the records of all patients who underwent WLC+BLC with HAL during a 34-month period at two institutions. We compared the incidence of adverse events (AEs) after initial and subsequent procedures. We grouped, graded and assigned degree of attribution for all AEs. We compared the incidence of AE after first versus subsequent use. Results: 181 patients underwent a total of 271 WLC+BLC. Of those 181 patients, 118 (65%) underwent WLC+BLC only 1 time. The other 63 (35%) patients underwent WLC+BLC 2 or more times: 44 (24%) of them 2 times, 18 (10%) of them, 3 or more times. We noted 89 AEs out of 271 procedures (33%), of which 66 (74%) occurred after the patient's 1st WLC+BLC; 14 (16%) after 2nd and 9 (10%) after 3rd or more. We found no statistically significant difference in frequency of AEs between those patients undergoing 1st versus 2nd WLC+BLC (P=0.134). In comparing the frequency of specific categories of AEs after first versus second WLC+BLC with HAL, there was no significant difference between the rates of specific AEs (Table 1). 89% of all adverse events were genitourinary in nature including dysuria, hematuria and bladder spasms. Four patients had hypersensitivity reactions including 1 with eye swelling, 1 with vision changes, 1 with penile swelling and 1 with rash. There was no statistically significant difference noted in the frequency of grades of AEs in patients undergoing 1st versus 2nd WLC+BLC with HAL (P=1.000) We observed one grade 3 and no grade 4 or 5 AE. There was no statistically significant difference in the frequency of each attribution rating between 1st versus 2nd WLC+BLC with HAL (P=0.250). None of the AEs were classified as probably or definitely related to HAL. Conclusion: In this retrospective study we found no statistically significant difference in the frequency, grade or attribution of AEs between 1st versus 2nd use of WLC+BLC with HAL.
30
Wed
Poster #4
SELF-REPORTED HEALTH AND STRESS AMONG PATIENT AND PARTNER DYADS PREPARING FOR CYSTECTOMY
Andrew Leone MD, Dominic Tang MD, Gregory Diorio DO, Wade Sexton MD, Michael Poch MD, Carl Henriksen MS, Paul Jacobsen PhD and Scott Gilbert MD
Moffitt Cancer Center Tampa FL
Presented by: Andrew Leone

Introduction and Objectives: Research among breast, prostate and colorectal cancer patient-partner dyads has shown that partners experience stress and anxiety at equal or higher levels compared to patients. However, little information is available for bladder cancer dyads. The objective of this study was to examine and compare self-reported physical and psychological health among dyads prior to radical cystectomy.
Methods: 41 dyads were recruited to this multi-institutional prospective study. Dyad participants completed several health questionnaires prior to RC (baseline assessment), including the SF-36 (general health), PHQ-8 (distress and depression), MOS-SS (sleep scale) and Coping Strategies Index (coping style). Participant responses were scored and compared between patients and partners using t-tests.
Results obtained: Mean age was 69 years and 66 years for patients and partners. The majority of patients were male (80.5%) and white (90% patients, 95% spouses). Half of household incomes were less than or equal to $60,000. Higher levels of avoidance (coping style) were seen among patients compared to partners (CSI mean scores 17.95 vs 15.05, p<0.0001). Mean SF-36 physical component scores were significantly lower in patients compared to spouses (37.37 vs. 51.32, p= <0.001). PHQ-8 scores were higher in patients compared to spouses (6.87 vs. 4.98, p= 0.04, PHQ-8> 10 cutoff for major depression). Other survey results were similar. Complete results are shown in Table.
Conclusions: Self-reported health indicators differed in physical and psychological health domains between patients and partners prior to RC, with patients reporting poorer health. Patients adopted avoidance more commonly as a coping strategy. These results contrast somewhat from studies investigating stress and depression symptoms among patient-partner dyads in other cancers.
30
Wed
Poster #5
RADICAL CYSTECTOMY COMPARED TO COMBINED MODALITY TREATMENT FOR MUSCLE-INVASIVE BLADDER CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS OF OVER 12,000 PATIENTS
Vishal Vashistha MD¹, Hanzhang Wang MD², Andrew Mazzone BS³, Michael Liss MD², Robert Svatek MD² and Dharam Kaushik MD²
¹Cleveland Clinic Foundation, Department of Internal Medicine; ²University of Texas Health Science Center at San Antonio, Department of Urology; ³Rush University Medical Center
Presented by: Vishal Vashistha

Purpose: Radical cystectomy (RC) has historically been the mainstay treatment for muscle-invasive bladder cancer (MIBC) while combined modality treatment (CMT-radiation therapy, concurrent chemotherapy and maximal transurethral resection of bladder tumor) is preserved for patients with substantial comorbidities. There is paucity of data comparing the efficacy of radical cystectomy with CMT for patients with MIBC. We sought to perform a comprehensive assessment of overall survival (OS), disease- specific survival (DSS), progression free survival (PFS) and treatment related complications between radical cystectomy and CMT

Methods: We searched seven major databases (PubMed, Scopus, EMBASE, Proquest, CINAHL, and the Registered Clinical Trials registry) for randomized-controlled trials (RCTs) and prospective and retrospective studies directly comparing RC with CMT from database inception to March 2016. We conducted meta-analyses using random effects models evaluating OS, DSS and PFS with hazard ratios (HR) and 95% confidence intervals (CI). Statistical heterogeneity among studies was evaluated using the I2 statistic. Risk of bias was assessed using the Newcastle-Ottawa Scale. Treatment toxicities were reviewed qualitatively.

Results: Nineteen studies evaluating 12,380 subjects were selected for systematic review. For studies eligible for meta-analyses, we found no statistically significant difference in OS at 5 years (HR: 0.96, favoring CMT, CI [0.72–1.29; p=0.778]) or 10 years (HR: 1.02, favoring cystectomy, CI [0.73–1.42; p=0.905]). No difference was observed in DSS at 5 years (HR: 0.83, favoring radiation, CI [0.54–1.28; p=0.390]) or 10 years (HR: 1.17, favoring cystectomy, CI [0.89–1.55; p=0.264]) or PFS at 10 years (HR: 0.85, favoring CMT, CI [0.43–1.67; p=0.639]). The cystectomy arms appeared to have a higher rate of early major complications while rates of minor complications were similar between the two treatments arms. All studies were defined as low or moderate risk of bias.

Conclusion: Current meta-analysis reveals no differences in OS, DSS, and PFS between radical cystectomy and CMT. Further randomized trials are necessary to identify the appropriate treatment for specific patients.
30
Wed
Poster #6
THE BURDEN OF CYSTOSCOPIC BLADDER CANCER SURVEILLANCE - ANXIETY, DISCOMFORT, AND PATIENT PREFERENCES FOR DECISION MAKING
Kevin Koo MD, MPH, MPhil¹, Lisa Zubkoff PhD², Brenda Sirovich MD, MS¹, John Seigne MBBS³, Philip Goodney MD, MS¹ and Florian Schroeck MD, MS³
¹White River Junction VAMC and Dartmouth College, Lebanon, NH; ²White River Junction VAMC; ³Dartmouth College, Lebanon, NH
Presented by: Florian Schroeck

Introduction and Objectives: Periodic cystoscopic surveillance involves a tradeoff for patients with Non-Muscle Invasive Bladder Cancer (NMIBC), who must balance their discomfort and anxiety related to cystoscopy against the risk for cancer recurrence. The 2016 AUA/SUO guideline specifically recommends shared decision making for these patients, although evidence on the topic is scarce. We examined patient discomfort, anxiety, and preferences for decision making in NMIBC to inform future work aimed at implementing shared decision making.
Methods: Veterans with a prior diagnosis of NMIBC were invited to complete the validated Customer Satisfaction Survey (CSS) assessing discomfort and worry and to participate in semi-structured focus groups to understand their experience and desire to be involved in surveillance decision making. Focus group transcripts were analyzed qualitatively, using (1) systematic iterative coding, (2) triangulation, involving multiple perspectives from urologists and an implementation scientist in the analyses, and (3) searching and accounting for disconfirming evidence.
Results: Twelve patients participated in three focus groups. Median number of lifetime cystoscopy procedures was 6.5 (interquartile range (IQR) 4-10). Survey responses showed participants expressing a high degree of discomfort (62, IQR 46-64, maximum possible (max) 70) and worry (36, IQR 31-42, max 42). Qualitative findings are summarized in the Table. Patients expressed substantial pre-procedural anxiety and worry about disease. Most did not perceive themselves as having a role in decision making on surveillance care. Preferences for decision making varied widely, ranging from acceptance of the physician’s recommendation to uncertainty to dissatisfaction with not being involved more in determining surveillance care.
Conclusion: Bladder cancer patients experience substantial discomfort, anxiety, and worry related to surveillance cystoscopy. While some are content with deferring surveillance decisions to their physicians, others would prefer to be more involved. Future work should focus on defining patients’ preferred approaches to surveillance decision making and on developing effective shared decision support tools.
30
Wed
Poster #7
INTERLEUKIN-17 IS SIGNIFICANTLY ELEVATED IN PATIENTS WHO FAIL TO RESPOND TO NEOADJUVANT CHEMOTHERAPY PRIOR TO CYSTECTOMY FOR BLADDER CANCER
Nathan Brooks MD¹, Michael Brumm BS² and Ken Nepple MD³
¹The University of Iowa Department of Urology; ²The University of Iowa Holden Comprehensive Cancer Center, Iowa City, Iowa; ³The University of Iowa Department of Urology, Iowa City, Iowa
Presented by: Nathan Brooks

Introduction and Objectives: Interleukin 17 (IL-17) is a cytokine associated with an increased neutrophil response. Neutrophils recruited by IL-17 producing cells actively suppress cytotoxic T cells. This suppression leads to increased tumor cell proliferation in mouse models of lung, prostate, and colon cancer. Little is known regarding IL-17 production in patients with muscle invasive bladder cancer (MIBC).

Methods: We analyzed the serum of 31 patients receiving neoadjuvant chemotherapy (NC) collected immediately prior to cystectomy. Using the Bio-Plex Pro™ Human Cytokine 17 plex assay, paired patient samples and controls were analyzed via the BioPlex 200 system. Concentrations of each cytokine analyzed was compared between patients responding to and failing to respond to NC.

Results Obtained: The mean (±standard deviation) concentration (pg/ml) for responders to chemotherapy (n=17) was 6.5 ± 1.8 vs 14.5 ± 3.6 for non-responders (n=14) a difference of 9.5 (p=0.046) (Figure). There was no significant difference for any of the other tested cytokines. IL-17 levels did not differ significantly based on age or gender or the presence of malnutrition or frailty.

Conclusions: IL-17 is significantly elevated in patients who fail to respond to neoadjuvant chemotherapy for MIBC. Further investigation is warranted to elucidate the role of IL-17 producing lymphocytes in MIBC.
30
Wed
Poster #8
MICROPAPILLARY BLADDER CANCER: INSIGHTS FROM THE NATIONAL CANCER DATABASE
Wilson Sui ¹, Justin T. Matulay MD¹, Maxwell James ¹, Dennis J. Robins MD¹, Ifeanyi Onyeji ¹, Marissa C. Theofanides MD¹, Arindam RoyChoudhury PhD², G. Joel DeCastro MD¹ and Sven Wenske MD¹
¹Department of Urology, Columbia University Medical Center, New York, NY; ²Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
Presented by: Maxwell James

Introduction: Micropapillary bladder cancer (MPBC) is a variant histology of urothelial carcinoma (UC) that is associated with poor outcomes however given its rarity, little is known outside of institutional reports. We sought to use a population-level cancer database to describe the epidemiology, treatment patterns and survival outcomes for MPBC.

Materials and Methods: The National Cancer Database (NCDB) was queried for all cases of MPBC and UC using International Classification of Disease-O-3 morphologic codes between 2004-2014. Primary outcome was survival outcomes stratified by treatment modality. Treatments included radical cystectomy (RC) with or without neoadjuvant chemotherapy (NAC) or adjuvant chemotherapy (AC).

Results: Overall 869 patients with MPBC and 389,603 patients with UC met the inclusion criteria. Median age of the MPBC cohort was 69.9 years (58.9–80.9) with the majority of the cohort presenting with high-grade (89.3%) and muscle invasive or locally advanced disease (47.6%). For cT1 MPBC, outcomes of RC and BPS were not statistically different. For ≥cT2 disease, NAC showed a survival benefit compared to RC alone for UC but not for MPBC. On multivariate analysis, MPBC histology independently predicted worse increased risk of death. On subanalysis of the MPBC RC patients, NAC did not improve survival outcomes compared to RC alone.

Conclusions: Neoadjuvant chemotherapy utilization and early cystectomy did not show a survival benefit in patients with MPBC. This histology independently predicts decreased survival and prognosis is poor regardless of treatment modality. Further research should focus on developing better treatment options for this rare disease.
30
Wed
Poster #9
BACILLUS CALMETTE-GUERIN STRAIN HAS NO SIGNIFICANT EFFECT ON RECURRENCE-FREE SURVIVAL WHEN USED INTRAVESICALLY WITH INTERFERON-ALPHA2B FOR NON-MUSCLE INVASIVE BLADDER CANCER
Ryan L. Steinberg MD¹, Nathan Brooks MD¹, Lewis J. Thomas MD¹, Sarah J. Mott MS² and Michael A. O'Donnell MD¹
¹University o f Iowa Health Care, Iowa City, IA; ²Holden Comprehensive Cancer Center, Iowa City, IA
Presented by: Ryan L. Steinberg

Introduction: Conflicting reports exist regarding disparate outcomes between Bacillus Calmette-Guerin (BCG) strains used as adjuvant treatment for non-muscle invasive bladder cancer (NMIBC). We aimed to assess if a difference in treatment failure exists between BCG strains when used with interferon (IFN). Methods: A post hoc analysis of the Phase 2 BCG/IFN study was performed. There were 901 patients with sufficient records for analysis. Enrollment criteria for the study was liberal. Beginning 3-8 weeks after transurethral resection or biopsy, patients received induction with 6 weekly intravesical treatments of BCG (TICE or Connaught) with 50 million units of IFN. Surveillance began 4-6 weeks after induction and continued quarterly for 2 years. Separate models were created for BCG naïve and failure patients. Multivariable analysis was performed using Cox proportional hazards regression. Results: Overall, 503 patients were BCG naïve and 398 patients had prior BCG failures with similar baseline characteristics. TICE BCG was used in 64.6% of BCG naïve patients and 71.4% of BCG failure patients. In BCG naïve patients, the 2 year recurrence-free survival (RFS) with BCG Connaught was improved on univariable analysis (65% vs TICE 54%, p=0.05) but not sustained on multivariable analysis (p=0.28). RFS at 2 years was similar between strains in BCG failure patients (TICE 44% vs Connaught 47%, p=0.53) in a multivariable model (Figure 1). Tumor focality, tumor size, and duration of disease (>2 years) were common variables associated with increased risk of treatment failure. In BCG failure patients, failure of 2 or more BCG induction courses and a BCG failure interval of less than 12 months were also associated with an increased risk of failure. Conclusion: No significant difference in RFS was evidenced between patients treated with TICE or Connaught BCG in combination with IFN.
30
Wed
Poster #10
IMPACT OF SURGICAL APPROACH TO CYSTECTOMY ON PERIOPERATIVE OUTCOMES: ANALYSIS OF DATA FROM THE NATIONAL CANCER DATABASE (NCDB)
Andrew Bachman , Alexander Parker , Marshall Shaw MD, Brian Cross MD, Kelly Stratton MD, Michael Cookson MD and Sanjay Patel MD
University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
Presented by: Andrew Bachman

OBJECTIVES: To examine the nation wide impact of surgical approach to cystectomy on perioperative outcomes. METHODS: We performed a retrospective cohort study of patients who underwent cystectomy for bladder cancer between 2010 and 2013 using the National Cancer Database (NCDB). Surgical approach was stratified by open vs. minimally invasive (robotic or laparoscopic). Demographic, structural, and pathologic characteristics were compared by surgical approach. Perioperative outcomes included surgical margins, length of postoperative stay, 30 and 90-day mortality, and 30-day postoperative readmission rates. Univariate analysis was performed using the chi-squared test and multivariate analysis was performed using binary logistic regression to identify factors associated with perioperative outcomes. RESULTS: A total of 9439 patients met our inclusion criteria of which 3218/6221 (34.1%) received a minimally invasive approach (MIA). Univariate analysis demonstrated a statistically significant association between open verses minimally invasive cystectomy and positive surgical margins (11.1% vs. 9.4%), length of hospital stay > 7 days (54.3% vs. 49.5%), mortality at 30 days (2.4% vs. 1.5%), and 30-day postoperative readmission rates (10.9% vs. 9.2%) (all P <0.02). Multivariate logistic regression analysis while controlling for covariates identified minimally invasive approach as predictor of shorter postoperative length of stay (P<0.0005), and decreased likelihood of readmission within 30 days (P<0.05). Minimally invasive approach alone was not significantly associated with positive or negative margins, 30-day postoperative mortality, or 90-day postoperative mortality (Table1). CONCLUSION: The use of minimally invasive surgical approach for cystectomy has been increasing with time particularly with increased surgeon familiarity with robotic techniques. Minimally invasive approach is predictive of shorter length of hospital stay and decreased likelihood of readmission, likely justifying the higher operative costs of minimally invasive surgery. DISCLOSURE: Funded by the University of Oklahoma College of Medicine - Department of Urology.
30
Wed
Poster #11
PREOPERATIVE MALNUTRITION AS A PREDICTOR OF POSTOPERATIVE MORBIDITY AND MORTALITY AFTER NEPHROURETERECTOMY FOR UPPER TRACT UROTHELIAL CARCINOMA
Matthew Katz MD, MBA¹, Daniel Wollin MD¹, Nicholas Donin MD², William Meeks ³, Scott Gulig ³, Lee Zhao MD¹, James Wysock MD¹, William Huang MD¹ and Marc Bjurlin MD4
¹Department of Urology, NYU Langone Medical Center, New York, NY; ²Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA; ³3 Data Management and Statistical Analysis Department, American Urological Association, Linthicum; 4Division of Urology, Department of Surgery, NYU Lutheran Medical Center, NYU Langone Health System, New York, NY
Presented by: Matthew Katz

Introduction and Objective: Nutritional status is increasingly recognized as an important predictor of prognosis in cancer patients. We evaluated the impact of preoperative malnutrition on morbidity and mortality following nephroureterectomy for upper tract urothelial carcinoma.

Methods: Using data from The American College of Surgeons National Surgical Quality Improvement Program (NSQIP), a risk-adjusted data collection mechanism for analyzing clinical outcomes including perioperative data, 30-day surgical complications, and mortality, we evaluated the association between variables suggestive of poor nutritional status and complications and overall mortality following nephroureterectomy. Preoperative variables suggestive of poor nutritional status included hypoalbuminemia (<3.5 vs. >3.5 g/dl), weight loss 6 months before surgery (>10%), and body mass index (BMI). The overall complication rate was calculated, and predictors of complications and mortality were identified using multivariable logistic regression models. All analyses were completed using IBM SPSS Statistics 23.

Results: A total of 1,106 patients were identified who underwent nephroureterectomy for upper tract urothelial carcinoma from 2005-2014. The overall complication rate was 15.2% (n=168) and mortality rate was 2.0% (n=22). On bivariable analysis, those with hypoalbuminemia (p<0.001) had significantly longer length of hospital stay, while BMI (p=0.057) was associated with longer operative times. After controlling for age, sex, medical comorbidities, medical resident involvement, operation year, operative time, and prior operation, hypoalbuminemia was found to be a significant independent predictor of postoperative complications (OR 1.95 95% Cl 1.09-3.46, p=0.024) and mortality (OR 5.76, 95% Cl 1.88-17.59, p=0.002).

Conclusions: Hypoalbuminemia is a significant predictor of an increased rate of surgical complications and, in addition to BMI is a predictor for mortality following nephroureterectomy for upper tract urothelial carcinoma. This finding highlights the importance of preoperative nutritional status in this population and suggests that interventions to improve nutrition preoperatively may improve outcomes.
30
Wed
Poster #12
CLINICAL OUTCOMES OF PATIENTS (PTS) WITH UPPER TRACT UROTHELIAL CARCINOMA (UTUC) BASED ON THE INTENSITY OF SURGICAL LOCOREGIONAL AND SYSTEMIC TREATMENT: A RISC MULTICENTER STUDY
Andrea Necchi MD¹, Gregory Pond PhD, PStat², Aristotelis Bamias MD³, Yu-Ning Wong MD4, Lauren Harshman MD5, Evan Yu MD6, Gunter Niegisch MD7, Ugo De Giorgi MD8, Rafael Morales-Barrera MD?, Sandy Srinivas MD¹°, Cora Sternberg MD¹¹, Ali-Reza Golshayan MD¹², Simon Crabb MD¹³, Sylvain Ladoire MD¹4, Ulka Vaishampayan MD¹5, Daniel Bowles MD¹6, Ajjai Alva MD¹7, Neeraj Agarwal MD¹8, Guru Sonpavde MD¹?, Matthew Milowsky MD²°, Thomas Powles MD²¹, Jonathan Rosenberg MD²², Matthew Galsky MD²³ and Joaquim Bellmunt MD, PhD5
¹Fondazione IRCCS Istituto Nazionale dei Tumori; ²McMaster University, Hamilton, Ontario, Canada; ³University of Athens, Athens, Greece; 4Fox Chase Cancer Center, Philadelphia, PA, USA; 5Dana-Farber Cancer Institute, Boston, MA, USA; 6University of Washington, Seattle, WA, USA; 7Heinrich-Heine-University, Düsseldorf, Germany; 8IRCCS Istituto Scientifico Romagnolo per lo studio e la Cura dei Tumori, Meldola, Italy; ?Vall d’Hebron Institute of Oncology, Vall d’Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain; ¹°Stanford University School of Medicine, Stanford, CA, USA; ¹¹San Camillo Forlanini Hospital, Rome, Italy; ¹²Medical University of South Carolina, Charleston, SC, USA; ¹³University of Southampton, Southampton, United Kingdom; ¹4Center Georges-François Leclerc, Dijon, France,; ¹5Karmanos Cancer Institute, Detroit, MI, USA; ¹6Denver Veterans Affairs Medical Center, Eastern Colorado Health Care System, Denver, CO, USA; ¹7University of Michigan, Ann Arbor, MI, USA; ¹8University of Utah, Salt Lake City, UT, USA; ¹?UAB Comprehensive Cancer Center, Birmingham, AL, USA; ²°University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, NC, USA; ²¹Barts Health and the Royal Free NHS Trust, Queen Mary University of London, London, United Kingdom; ²²Memorial Sloan-Kettering Cancer Center, New York, NY, USA; ²³Mount Sinai School of Medicine, Tisch Cancer Institute, New York, NY, USA.
Presented by: Andrea Necchi

Background:
The optimal management of pts with UTUC is unknown, in particular regarding the need for, and extent of, lymph-node dissection (LND) and the role of perioperative chemotherapy (CT).
We evaluated the impact of diverse surgical locoregional and systemic treatment on outcomes of pts with UTUC.

Methods:
We conducted an analysis from the database of Retrospective International Study of Invasive/Advanced Cancer of the Urothelium (RISC) database, which is a retrospective study of pts with muscle-invasive or advanced UC. Data from 22 centers was collected and surgery was performed between 02/1997 and 02/2013. Kaplan-Meier estimates were used to estimate time-to-event outcomes such as relapse-free survival (RFS) or overall survival (OS). Cox regression analyses were performed to evaluate potential prognostic factors. The log-rank and χ2 test were used to compare differences in clinical outcomes between pN stages and between subgroups according to adjuvant CT (ACT). All tests were 2-sided and statistical significance was defined as a p-value ≤0.05.

Results:
198 pts were included in this analysis. 69.7% had primary tumor in the renal pelvis, 30.3% in the ureter, 5.1% only had non-UC histological variants. 75 pts (37.9%) had no LN removed (pNx), 8 (4%) received neoadjuvant (NA) CT, 67 (33.8%) ACT. The number of removed LN was not univariably associated with RFS (p=0.38) nor with OS (p=0.28). Results of multivariable analyses for RFS and OS are shown in the table. The benefit of ACT on OS was mainly seen in ‘anyT,pNx’ and in ‘anyT,pN1-3’ pathologic categories (p=0.007 and p=0.037, respectively).
pN stage (pNx/pN0/pN1-3) was not associated with the site of relapse (retroperitoneal LN vs pelvic LN vs liver-lung-bone/other) (p=0.76) but pts with pNx or pN1-3 stages were more likely to relapse ≤6 month vs pN0 pts (42.7 and 47.6% vs 13.3%, respectively, p<0.001).

Conclusions:
In our analysis, the extent of LN removal in UTUC was not associated with improved outcome, although notably pNx pts had a similar early relapse-rate as proven pN-positive pts.
Conversely, ACT seemed to be equally effective across the pN stages, including pNx, and should be considered for all pts if no NACT was given.
30
Wed
Poster #13
ASSOCIATION OF PERIOPERATIVE VENOUS THROMBOEMBOLISM WITH LONG-TERM ONCOLOGIC OUTCOMES FOLLOWING RADICAL CYSTECTOMY
Harras Zaid MD, Matthew Tollefson MD, Igor Frank MD, William Parker MD, R. Houston Thompson MD, Robert Tarrell , Prabin Thapa , John Cheville MD and Stephen Boorjian MD
Mayo Clinic, Rochester MN
Presented by: Harras Zaid

Introduction and Objectives: Venous thromboembolism (VTE) has been reported to occur in 2-5% of patients undergoing radical cystectomy (RC). While VTE is an important cause of perioperative morbidity, the association of these events with long-term cancer prognosis has not been established. Herein, we evaluated the association of perioperative VTE with patients’ risk of subsequent disease recurrence and mortality.

Methods: We reviewed 2889 patients undergoing RC between 1980-2009 at the Mayo Clinic to identify patients diagnosed with a VTE within 90 days of RC. These cases were then matched in a 1:2 fashion to control patients undergoing RC who did not develop VTE. Matching was performed on the basis of age, BMI, receipt of neoadjuvant chemotherapy, and pathologic T and N stages. Recurrence-free (RFS), cancer-specific (CSS), and overall survival (OS) were estimated utilizing the Kaplan-Meier method and compared with the log-rank test.

Results: A total of 132 patients with a VTE within 90 days of RC were identified, accounting for 4.6% of all patients analyzed. These cases were matched to 257 controls per criteria noted above, and were overall well-matched (Table). Of the 389 patients in this study, median follow-up after RC was 9.2 years, during which time 152 (39%) patients experienced recurrence and 306 (78%) died, including 157 (40%) who died of bladder cancer. We found no significant difference in 5-year RFS (59% versus 61%; p=0.75); CSS (57% versus 64%; p=0.13); or OS (45% versus 50%; p=0.15) between patients with versus without perioperative VTE, respectively.

Conclusion: We found that VTE within 90 days of RC did not significantly impact long-term cancer outcomes. While these events represent an important cause of perioperative morbidity, no interaction with oncologic control was noted, and patients may be counseled accordingly.
30
Wed
Poster #14
THE PREVALENCE OF PREOPERATIVE MALNUTRITION: A PROSPECTIVE STUDY OF PATIENTS UNDERGOING CYSTECTOMY
Conrad Tobert MD, Nathan Brooks MD, Lewis Thomas MD, Chermiane Hung BS and Kenneth Nepple MD
University of Iowa Hospitals and Clinics, Department of Urology, Iowa City, IA
Presented by: Conrad Tobert

Introduction: Radical cystectomy is the gold standard for treatment of muscle invasive bladder cancer. Perioperative morbidity is common and has been reported as high as 65%, making identification of any at-risk patients imperative. In cystectomy patient, malnutrition may be under-recognized. In addition, accurate clinical documentation using recommended methodology is important for appropriate hospital reimbursement.
Objectives: 1) Assess the prevalence of preoperative malnutrition in cystectomy patients using the currently recommended tool for malnutrition diagnosis (Academy/ASPEN Consensus Statement for the Identification and Documentation of Malnutrition), which is based on the presence of at least two of six clinical characteristics. 2) Determine the association of preoperative patient characteristics with malnutrition.
Methods: All cystectomy patients at our institution from January 2015 to June 2016 were prospectively evaluated by a registered dietician at their preoperative visit using the recently published Consensus Statement criteria, the current gold standard for malnutrition diagnosis.
Results: Preoperative malnutrition was present in 24 of 83 (28.9%) cystectomy patients. Of the patients with malnutrition: 11 (46%) had mild malnutrition, 4 (17%) had moderate malnutrition and 9 (38%) had severe malnutrition. Among the six individual clinical characteristics for malnutrition: 18 (21.0%) had decreased caloric intake, 34 (40.9%) had weight loss, 31 (37.3%) had loss of subcutaneous fat, 33 (39.7%) had loss of muscle mass, 25 (30.1%) had the clinical presence of edema, and 23 (27.7%) had decreased grip strength. Malnutrition was more common in patients that were male (p<0.01), lower BMI (p<0.01), and longer distance from our institution (p=0.04). Age, marital status, charlson comorbidity index, neoadjuvant chemotherapy, surgical pathology and nodal status were not associated with preoperative malnutrition.
Conclusions: Malnutrition is common in patients undergoing cystectomy. Preoperative assessment with a standardized methodology provides a model for identification of at risk patients and appropriate clinical documentation. Further analysis of the effect of malnutrition on perioperative outcomes will be forthcoming.

Disclosure: Supported by American Cancer Society Institutional Seed Grant.
30
Wed
Poster #15
THE ASSOCIATION OF AGE WITH UTILIZATION AND OUTCOMES OF RADICAL CYSTECTOMY FOR HIGH-GRADE NON-MUSCLE INVASIVE BLADDER CANCER: RESULTS FROM THE NATIONAL CANCER DATA BASE
William Parker MD, Harras Zaid MD, Elizabeth Habermann PhD, Igor Frank MD, R. Houston Thompson MD, Matthew Tollefson MD, R. Jeffrey Karnes MD and Stephen Boorjian MD
Mayo Clinic, Rochester, MN
Presented by: William Parker

Introduction and Objectives: Radical cystectomy (RC) is a preferred option for high-risk non-muscle invasive bladder cancer (NMIBC), particularly after failure of intravesical therapy. However, clinicians may be reluctant to offer surgery to older patients given concerns regarding morbidity. We sought to evaluate the association of age with utilization and clinicopathologic outcomes of RC for NMIBC.

Methods: The National Cancer Data Base was queried to identify patients with high-grade NMIBC from 2004-2013. Patients were stratified according to age at diagnosis: <60, 61-70, 71-80, >80 years. Multivariable logistic regression was performed to assess the association of age group with utilization of RC, pathologic upstaging to pT2-4 or pN+, as well as 30- and 90-day mortality after surgery. Overall survival (OS) was compared using the Kaplan-Meier method and log-rank test.

Results: A total of 63,402 patients were identified with NMIBC, of whom only 3,641 (5.7%) underwent RC. Utilization of RC remained relatively constant over the study period (4.3%-6.8%; p=0.44). On multivariable analysis (Table), increasing age was inversely associated with RC utilization. In patients who underwent RC, pathologic upstaging was identified in 1,445 (40%) patients, with no independent association noted between age and upstaging risk. Patients 61-80 did not have a significantly increased risk of perioperative mortality versus patients <60, while age >80 was associated with increased risks of 30 (OR 3.42; p=0.02) and 90-day mortality (OR 3.81; p<0.01). Notably, NMIBC pathologic tumor stage remained associated with improved OS compared to progression to pT2-4 or N+ disease at RC for all age groups, with the median OS improvement not reached in those under 60; 31 months in those 61-70; 54 months in those 71-80; and 36 months in those over 80 (all p<0.01).

Conclusions: Despite similar risks of pathologic upstaging, older patients are significantly lass likely to receive a RC. Perioperative mortality is higher in patients >80, although an OS benefit to pathologic NMIBC at RC is maintained across age strata, emphasizing the importance of balancing competing causes of death in these patients.
30
Wed
Poster #16
EFFICACY, SAFETY AND BIOMARKERS OF FIRST-LINE (1L) ATEZOLIZUMAB (ATEZO) IN CISPLATIN (CIS)-INELIGIBLE LOCALLY ADVANCED OR METASTATIC UROTHELIAL CARCINOMA (MUC): A PHASE II IMVIGOR210 STUDY UPDATE
Matthew Galsky ¹, Joaquim Bellmunt ², Arjun Balar ³, Yohann Loriot 4, Christine Theodore 5, Enrique Grande 6, Daniel Castellano 7, Margitta Retz 8, Günter Niegisch ?, Sergio Bracarda ¹°, Andrea Necchi ¹¹, Ulka Vaishampayan ¹²,¹³, Srikala Sridhar ¹4, Bernhard Eigl ¹5, Syed Hussain ¹6, Michiel van der Heijden ¹7, Alexandra Drakaki ¹8, Beiying Ding ¹?, Richard Bourgon ¹?, Sanjeev Mariathasan ¹?, AnnChristine Thåström ¹?, Oyewale Abidoye ¹? and Jonathan Rosenberg ²°
¹Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY; ²Bladder Cancer Center, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA; ³Perlmutter Cancer Center, NYU Langone Medical Center, New York, NY; 4Gustave Roussy, Villejuif, France; 5Department of Oncology, Hôpital Foch, Suresnes, France; 6Hospital Universitario Ramón y Cajal, Madrid, Spain; 7Doce de Octubre University Hospital, Madrid, Spain; 8Urologische Klinik und Poliklinik, Technische Universität München, Munich, Germany; ?Department of Urology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; ¹°USL Toscana Sud-Est Ospedale San Donato, Arezzo, Italy; ¹¹Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy; ¹²Karmanos Cancer Institute, Detroit, MI, USA; ¹³13Princess Margaret Cancer Center, Toronto, ON; ¹4Princess Margaret Cancer Center, Toronto, ON, Canada; ¹5BCCA Vancouver Cancer Centre, Vancouver, Canada; ¹6University of Liverpool, Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK; ¹7Netherlands Cancer Institute, Amsterdam, the Netherlands; ¹8UCLA Medical Center, Los Angeles, CA; ¹?Genentech, Inc., South San Francisco, CA; ²°Memorial Sloan Kettering Cancer Center, New York, NY
Presented by: Matthew Galsky

Introductions and Objectives. Most mUC patients (pts) never receive 1L standard cis-based chemotherapy, and treatments (Tx) for cis-ineligible pts are accompanied by short response durations, minimal OS benefit and toxicity. As a result, 1L cis-ineligible disease has high unmet need. mUC has a high mutation load (ML) that may be associated with clinical benefit from atezo (anti–PD-L1). Here we further examine atezo in the 1L setting (including ORR, DOR, OS) and in exploratory studies correlated OS with ML.

Methods. Pts had no prior Tx for mUC; cis-ineligibility criteria included renal impairment (GFR <60 and >30 mL/min), ECOG PS 2 and/or ≥G2 hearing loss or peripheral neuropathy. Pts received atezo 1200 mg IV q3w until RECIST v1.1 PD. The primary endpoint was ORR (central review); DOR and OS were key secondary endpoints. ML was estimated by genomic profiling using a 315-gene FoundationOne panel.

Results Obtained. 70% of 119 evaluable pts were cis ineligible due to renal impairment. In all pts, confirmed ORR was 24%, with a 7% CR rate (Table). 21/28 responses were ongoing at March 14, 2016 data cut off (14.4-mo median follow-up), with mDOR not reached (range 3.7-16.6+ wk). Responses occurred regardless of PD-L1 status and in pts with poor prognostic factors (Table). The all-pt mOS was 14.8 mo (95% CI 10.1 mo-NE; 47% event:pt ratio). Evaluable pts whose tumor samples had highest ML (>16 and ≤62.2 mut/megabase [MB]; highest quartile) had significantly longer OS vs those with lower ML (≤16 mut/MB): P=0.0079 (HR 0.3023 [95% CI 0.1186-0.7700]). Median Tx duration was 15 wk. Atezo was well tolerated: 66% had a Tx-related AE (commonly fatigue, pruritus, diarrhea); 6% had an AE that led to atezo withdrawal; 6% had a G3-4 immune-mediated AE. 1 Tx-related G5 AE, sepsis, was reported. Updated clinical and biomarker data (≈16-mo follow-up) will be presented.

Conclusions. Encouraging DOR, OS and tolerability were seen in cis-ineligible mUC pts treated with 1L atezo. Exploratory analyses showed that OS was associated with genomic factors such as ML. These data support atezo in this setting of unmet need and suggest that pts may be successfully treated without chemotherapy. Sponsor: F. Hoffmann-La Roche Ltd. NCT02108652.
30
Wed
Poster #17
ASSOCIATION OF PRIOR PELVIC RADIATION WITH LONG-TERM ONCOLOGIC OUTCOMES FOLLOWING RADICAL CYSTECTOMY
Harras Zaid MD, Matthew Tollefson MD, Igor Frank MD, William Parker MD, R. Houston Thompson MD, Robert Tarrell MD, Prabin Thapa MD, John Cheville MD and Stephen Boorjian MD
Mayo Clinic, Rochester MN
Presented by: Harras Zaid

Introduction and Objective: Receipt of pelvic radiotherapy (PRT) prior to radical cystectomy (RC) has unclear association on oncologic outcomes.

Methods: The Mayo Clinic cystectomy registry was queried to review 2139 patients undergoing RC for M0 bladder cancer between 1990 and 2010. We then identified patients receiving PRT prior to RC, and matched these cases to non-radiated controls (~1:2) on the basis of age, sex, receipt of neoadjuvant chemotherapy, and pathologic T and N stages. Cancer-specific survival (CSS), and progression-free survival (PFS) were estimated using the Kaplan-Meier method and compared with the log-rank test.

Results: Of 2139 patients undergoing RC, 104 (4.9%) had received PRT prior to surgery. These patients were matched to 191 non-radiated control patients (no PRT). Overall, patients were well-matched on disease and patient characteristics (Table). Median follow-up was 9.6 years (IQR 6.0, 14.8). During this time, 108 patients experienced disease recurrence and 218 died, including 122 who died from bladder cancer. Five-year CSS among patients who did versus did not receive PRT was 55% versus 63% (p=0.10), while the 5-year PFS was 55% versus 61% (p=0.32). Furthermore, the pattern of disease recurrence (abdominal/visceral, urothelial, local/pelvic, thoracic, soft tissue/other) did not differ between the no PRT and PRT groups (all p>0.05).

Conclusion: Receipt of PRT prior to RC is not associated with worse oncologic outcomes. While prior PRT may increase surgical complexity, CSS, PFS, and patterns of recurrence are similar to patients who have not received PRT.
30
Wed
Poster #18
NEOADJUVANT VASCULAR TARGETED PHOTODYNAMIC THERAPY IN UROTHELIAL CANCER – PRECLINICAL DATA
Barak Rosenzweig MD¹, Renato B. Corradi MD², Sadna Budhu PhD³, Ricardo Alvim MD², Pedro Recabal MD², Stephen La Rosa -², Sylvia Jebiwott -², Alex Somma -², Sebastien Monette MD4, Avigdor Scherz PhD5, Kwanghee Kim PhD² and Jonathan A. Coleman MD6
¹Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY; ²Department of Surgery, Sloan-Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY; ³Immunology Program, The Jedd Wolchok Lab, Memorial Sloan Kettering Cancer Center, New York, NY; 4Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY; 5Department of Plant Sciences, Weizmann Institute of Science, Rehovot, Israel; 6Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY. Weill Cornell Medical College, New York, NY
Presented by: Barak Rosenzweig

Background: Recurrence rate following surgical treatment of locally advanced urothelial cancer is high. Despite guidelines recommendation, neoadjuvant chemotherapy acceptance rate falls below 12%. We examined the efficacy and mechanism of neoadjuvant sub-ablative vascular targeted photodynamic therapy (sbVTP) in urothelial cancer.
Methods: We used WST-11 (TOOKAD® Soluble, Steba Biotech, France) as a photosensitizer for sbVTP, followed by surgical tumor resection in a mouse model. Therapeutic efficacy was evaluated by systemic luminescent imaging and survival studies of 10-25 mice per group. Immunohistochemistry and flow cytometry were used to elucidate mechanism. Kaplan-Meier, Mann-Whitney and Fischer exact test were used to analyze the data. All statistical tests were two-sided.
Results: Tumor volume at day of surgery was 1222 mm3 (95% CI 976-1468 mm3) and 135 mm3 (95% CI 66-204 mm3) for none sbVTP treated animals vs. sbVTP treated animals, respectively (P<0.0001). Systemic progression rate at surgery day was 30% vs. 7%, accordingly (p<0.05). Median progression free and overall survival were 45 and 55 days for surgery only group, respectively, and have not been reached for the sbVTP + surgery group (p<0.05) (Fig.1). Local recurrence rates were significantly lower accordingly. Early antigen presenting cells rise followed by long term memory, effectory and active T-cells increase in spleen, lungs and blood was induced by sbVTP. Tumors following sbVTP showed intermittent positive signal (‘blinking’) which may represent an ongoing immune response.
Conclusions: sbVTP as neoadjuvant treatment in urothelial cancer, delayed local and systemic progression prior surgery, followed by prolonged progression free survival, overall survival, and reduced local recurrence thereafter. Immune based mechanism was established to induce its long term effect.
Support: NIH grant P30-CA008748. Sidney Kimmel Center for Prostate and Urologic Cancers
30
Wed
Poster #19
THE EFFECT OF ADJUVANT CHEMOTHERAPY FOR PATIENTS WITH ADVERSE PATHOLOGY AFTER NEOADJUVANT CHEMOTHERAPY FOR MUSCLE INVASIVE BLADDER CANCER
William Parker MD, Elizabeth Habermann PhD, Courtney Day BS, Harras Zaid MD, Igor Frank MD, R. Houston Thompson MD, Matthew Tollefson MD, Stephen Boorjian MD and R. Jeffrey Karnes MD
Mayo Clinic, Rochester, MN
Presented by: William Parker

Introduction and Objectives: While neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) is recognized as the standard of care, the management of patients with locally advanced and/or nodal disease after NAC and radical cystectomy (RC) is not well defined. We sought to evaluate the association of adjuvant chemotherapy (AC) and overall survival (OS) among patients with adverse pathology after NAC and RC.

Methods: The National Cancer Database was reviewed to identify patients with adverse pathology (pT3N0, pT4N0, or pTanyN1-3) at RC following NAC from 2006-2012. Patients were stratified by receipt of AC. Clinical and pathologic variables were abstracted. OS was the primary end-point and differences on the basis of AC were assessed using the Kaplan-Meier method and log-rank test. Multivariable Cox proportional hazards regression was used to assess the association of AC with OS controlling for age, sex, race, Charlson score, year of diagnosis, pathologic stage, and receipt of adjuvant radiotherapy.

Results: Adverse pathology following NAC and RC was identified in 1,361 patients from 2006-2012, of whom 328 (24.1%) received AC. Staging was pT3N0 in 444 (32.6%), pT4N0 in 162 (11.9%), and pTanyN1-3 in 755 (55.5%). Median OS for the entire cohort was 22.9 months, which differed by pathologic stage: 34.6, 21.4, and 19.3 months in patients with pT3N0, pT4N0, and pTanyN1-3, respectively (p<0.01). No difference in OS was noted by receipt of AC (median OS of 24.6 months with AC vs 22.0 months without AC; p=0.18). When stratified by pathologic stage, median OS was no different comparing patients receiving AC to those without AC: pT3N0: 37.9 vs 34.6 months (p=0.97), pT4N0: 23.4 vs 18.7 months (p=0.22), and pTanyN1-3: 22.7 vs 18.2 months (p=0.06). On multivariable analysis, receipt of AC was not associated with a significant difference in the risk of overall mortality (HR 0.86; 95%CI 0.74-1.01; p=0.06) for all patients. When stratified by stage, AC was associated with a reduced mortality in patients with pT4N0 disease (HR 0.56; 95%CI 0.33-0.97; p=0.04), but not pT3N0 or pTanyN1-3 (p>0.05).

Conclusion: Patients with adverse pathology at RC after NAC have a median OS of approximately 2 years which is influenced by pathologic stage. The receipt of AC for these patients was not associated with improvements in survival except in patients with pT4N0 disease, suggesting that use of AC for adverse pathology may not be warranted in all cases.
30
Wed
Poster #20
FACTORS ASSOCIATED WITH FAVORABLE PATHOLOGY AT RADICAL CYSTECTOMY AFTER PRIOR INTRAVESICAL THERAPY FOR NON-MUSCLE INVASIVE BLADDER CANCER.
William Parker MD, Harras Zaid MD, Prabin Thapa MS, Matthew Tollefson MD, Igor Frank MD, R. Houston Thompson MD, Stephen Boorjian MD and R. Jeffrey Karnes MD
Mayo Clinic, Rochester, MN
Presented by: William Parker

Introduction and Objectives: The management of non-muscle invasive bladder cancer (NMIBC) failing first line intravesical therapy (IVT) is either radical cystectomy (RC) or alternative IVTs, which are traditionally not as effective after prior IVT failure. RC is a morbid procedure and not all patients harbor invasive disease at final pathology. Thus, there exists a need to identify factors which may be associated with favorable pathology at RC. We therefore sought to evaluate clinical and pathologic features associated with either pathologic complete response (pT0N0) or persistent non-invasive disease (
Methods: We retrospectively reviewed patients with NMIBC who underwent RC after at least one prior IVT. Clinicopathologic features including age, gender, time from diagnosis to RC, presence of lymphovascular invasion (LVI), cT-stage, multifocality, number of prior intravesical recurrences, type of treatment, and number of prior courses (1 versus 2 or more) were abstracted. Multivariable logistic regression was used to evaluate their association with pT0N0 or
Results: We identified 406 patients from 1980-2012 who underwent RC for NMIBC after at least one prior course of IVT (BCG: n=173 (42.6%), BCG + IFN: n=49 (12.1%), other IVT: n=184 (45.3%)). Of these patients, 93 (22.9%) were pT0N0 and an additional 243 (59.8%) were
Conclusions: These data indicate that for patients with IVT failure, lower clinical stage and recurrences after a BCG based regimen are associated with a greater odds of pT0N0 or