Abstracts from the Mid-Atlantic Section of the AUA 2020

© The Canadian Journal of Urology TM : International Supplement, October 2020 Podium Session A Evaluation of Survival Benefit of Combination of Local Treatment and Systemic Chemotherapy for Node-Positive Non-Metastatic Bladder Cancer Using a National Cancer Database A. Elbakry; C. Ferari; T. Trump; M. Mattes; A. Luchey West Virginia University School of Medicine, Morgantown, WV, USA Introduction: Though historically grouped in with true metastatic disease and treated with palliative chemo, those with clinically node-positive non-metastatic bladder cancer have been the target of several recent studies aiming to establish a standard of care for this potentially treatable population.Ahandful of studies have shown a significant survival benefit for various multimodal therapy approaches. Our study aims to evaluate the effect of various combinations of treatment modality on long-term survival in a large cohort of this patient population. Materials &Methods: Data from theNational Cancer Databasewas used to identify patients who had node-positive non-metastatic bladder cancer who received chemotherapy alone or in combination with radical cystectomy or radiotherapy. We identified 3481 eligible cases who were included in the final analysis. Baseline patient demographic data was compared using ANOVA test for continuous variables and Chi-square test for categorical variables. Kaplan-Meier test was used for survival analysis and Cox-Regression was used for multivariable analysis. Results: Baseline demographic data is summarized in table 1. Patients who were offered radical cystectomy were significantly younger (P = 0.00). There was a significant difference between the groups regarding racial distribution, facility type, and insurance status. There was no difference in gender, Charlson\Deyo score, or financial and educational status between the groups. Combination of radical cystectomy and chemotherapy was found to be significantly superior to other options with mean survival time of 27 months, ranging from 24.7 to 29.3 months (P = 0.000). Multivariable analysis showed that final treatment, age, and facility type were significant survival predictors, while race and insurance status failed to maintain significance. There was no survival difference between the chemotherapy group and the chemo-radiotherapy group. Conclusions: The combination of surgery and chemotherapy achieves statistically significant superior long-term survival in clinically node-positive non-metastatic bladder cancer patients. Adding radiotherapy to chemotherapy did not improve survival in this group of patients. Renal Laceration: A 10-Year Institutional and 7-Year Protocol Review Z. Werner; E. Bacharach; J. Knight-Davis; A. Luchey West Virginia University, Morgantown, WV, USA Introduction: Current renal laceration guidelines recommend conservative management. In 2012 we initiated an institution-wide renal laceration protocol to standardize management. This protocol involves an algorithm for initiation of deep vein thrombosis (DVT) prophylaxis, cessation of bed rest, and frequency of laboratory studies. We hypothesized that low-grade injuries (Grade I-III) could be managed without urologic consultation and our DVT prophylaxis regimen would not pose increased risk of hemorrhage requiring transfusion. Materials & Methods: We retrospectively reviewed all renal lacerations at our institution from 2009-2019. We segregated injuries based on grade, presence of multi-trauma, and evaluated presence and type of intervention, initiation and type of DVT prophylaxis, and post-DVT prophylaxis hemorrhage requiring transfusion. Results: We identified 296 cases of renal laceration, of which 61 were isolated injuries. There were 221 low-grade lacerations and 75 high-grade lacerations. No grade 1 or 2 lacerations required any interventions. (2/79) Grade 3 lacerations required IR embolization. (25/62) Grade 4 lacerations required intervention (5/25 nephrectomy). (7/13) Grade 5 lacerations required intervention, (5/7) being nephrectomies. In no cases of isolated renal injury did initiation of DVT prophylaxis result in delayed hemorrhage requiring transfusion. Conclusions: Only 2/221 low-grade renal lacerations required intervention. Our data suggest that grade 1-2 renal lacerations can bemanaged safelywithout urologic consultation. Consultation is warranted for grade 3 injuries given the possibility of initial understaging and intervention rate for grade 4 injuries. Further, we believe our renal laceration protocol in our admittedly small, isolated sample size has shown our DVT prophylaxis initiation to not place patients at any increased risk. PDA-04 PDA-02 6 Variables Group 1 Chemothera py only Group 2 Radical Cystectomy and Chemotherapy Group 3 Chemo- Radiotherapy Group 4 Radical Cystectomy and Chemo-Radiotherapy P value No. 1312 1316 726 127 Patient demographics Age, mean (SD) 66.97 (11) 63.80 (9.68) 69.42 (11.69) 64.28 (10.21) 0.000 Male, n. (%) 954 (72.7%) 945 (71.8%) 508 (70%) 86 (67.7%) 0.437 White, n. (%) 1167 (88.9%) 1210 (91.9%) 635 (87.5%) 117 (92.1%) 0.005 Charlson\Deyo score, n. (%) 0.545 0 977 (74.5%) 978 (74.3%) 562 (77.4%) 97 (76.4%) 1 247 (18.8%) 265 (20.1%) 124 (17.1%) 23 (18.1%) 2 88 (6.7%) 73 (5.5%) 40 (5.5%) 7 (5.5%) Primary payer n. (%) 0.000 uninsured 60 (4.6%) 48 (3.6%) 26 (3.6%) 5 (3.9%) private 411 (31.3%) 560 (42.6%) 167 (23%) 40 (31.5%) Medicaid 104 (7.9%) 92 (7%) 54 (7.4%) 11 (8.7%) Medicare 724 (55.2%) 597 (45.4%) 467 (64.3%) 69 (54.3%) Other government 13 (1%) 19 (1.4%) 12 (1.7%) 2 (1.6%) Median household income, n. (%) 0.088 <38,000 235 (17.9%) 185 (14.1%) 119 (16.4%) 23 (18.1%) 38,000-47,999 329 (25.1%) 333 (25.3%) 198 (17.3%) 37 (29.1%) 48,000-62,999 382 (29.1%) 366 (27.8%) 197 (27.1%) 34 (26.8%) >63,000 366 (27.9%) 432 (32.8%) 212 (29.2%) 33 (26%) No high school diploma, n. (%) 0.069 ≥ 21% 222 (16.9%) 187 (14.2%) 120 (16.5%) 17 (13.4%) 13%-20.9% 342 (26.1%) 346 (26.3%) 204 (28.1%) 27 (21.3%) 7%-12.9% 456 (34.8%) 455 (34.6%) 266 (36.6%) 51 (40.2%) <7% 292 (22.3%) 328 (24.9%) 136 (18.7%) 32 (25.2%) Facility characteristics Facility type, n. (%) 0.000 Community 119 (9.1%) 90 (6.8%) 83 (11.4%) 21 (16.5%) Comprehensive 484 (36.9%) 389 (29.6%) 354 (48.8%) 50 (39.4%) Academic/Research 544 (41.5%) 741 (56.3%) 216 (29.8%) 40 (31.5%) Integrated cancer program 165 (12.6%) 96 (7.3%) 73 (10.1%) 16 (12.6%)