Abstracts from the Abstracts from the Mid-Atlantic Section of the AUA 2021

MA-AUA 2021 Abstracts Moderated Poster Session 4: Kidney/Bladder/Penile/Testicular/ Adrenal Cancer MP4-03 Social Factors Influence Treatment Decisions in Node-Positive Non- Metastatic Bladder Cancer T. Trump, A. Elbakry, K. Aldabek, A. Luchey West Virginia University, Morgantown, WV, USA Introduction and Objective: Though historically grouped in with true metastatic disease and treated with palliative chemotherapy, 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. Prior retrospective studies have indicated that patients treated with combination chemotherapy and radical cystectomy (RC) have prolonged survival compared to other therapies. The objective of this study is to identify if social factors influence treatment in this patient population. Methods: Data from the National Cancer Database was used to identify patients who had node-positive non-metastatic bladder cancer disease who received chemotherapy alone or in combination with radical cystectomy (RC) or radiotherapy. We identified 3,481 eligible cases who were included in the final analysis. Baseline patient demographic datawas compared usingANOVA test for continuous variables, and Chi-square test for categorical variables. Results: There was a significant difference between the groups regarding age, racial distribution, facility type and insurance status. Patients were more likely to receive RC if they were: of younger age, of white race, receiving their care at an academic hospital, and/or privately insured. There were no differences noted regarding sex, median household income, or highest level of education. (Table 1) Conclusions: Prior studies have indicated that there is a survival benefit for chemotherapy plus RC in this patient population. This study identifies social factors that appear to influence treatment decisions, which may in turn, influence survival. Residual/UpgradedDisease at Time of Re-TURWhen Bluelight Cystoscopy Used as Primary Procedure for Non-muscle Invasive Bladder Carcinoma A. Cruz-Bendezu 1 , E. Dadashian 1 , A. Elovic 1 , B. Zollinger 1 , S. Akosman 1 , M. Whalen 1,2 1 The George Washington School of Medicine and Health Sciences, Washington, DC, USA; 2 GWU Medical Faculty Associates, Washington, DC, USA Introduction and Objective: Current guidelines recommend planned repeat transurethral resection (TUR) after whitelight cystoscopy (WLC) for high-risk non-muscle invasive bladder cancer (NMIBC). Recent studies have demonstrated that Blue Light Cystoscopy (BLC) increases tumor detection during initial resection. This study sought to compare the rates of residual disease and upgrading in patients treated with and without BLC at a single institution. Methods: Our institutional cancer database was retrospectively queried for patients who underwent TUR for NMIBC from 2014 to 2020. Information regarding disease grade, stage, “upstaging”, and use of bluelight optics was extracted. “Upgrading” was defined as higher grade or cT stage at re-TUR. Descriptive statistics, chi-square tests, and the Cox Proportional Hazards model were used for analysis. Results: Atotal 92 patients were included. Overall, 28 patients had BLC at their first procedure, and 64 had WLC first with subsequent BLC. In total, 43% and 36% of high-risk patients received re-TUR, in the BLC-initial and WLC-initial groups, respectively. The rates of residual or upgraded disease at re-TURwere 42% for the BLC-initial group compared to 78% for the WLC-initial group (RR 0.37, 95% CI 0.15-0.93; P=0.07). Among patients with “high risk” NMIBC, the rates of residual or upgraded re-TUR were 43% for the BLC-initial group compared to 69% for the WLC-initial group (RR 0.67; 95% CI 0.31-0.43; P=0.5). Multivariable analysis revealed no significant impact for upgrading/residual disease at re-TURwhen adjusting for age, current tobacco use, disease stage at first TUR, and use of BLC at initial procedure (LR 2.23, P = 0.69). Conclusions: Using BLC at initial TUR resulted in lower rates of residual disease compared to initial WLC. Despite initial BLC use, residual disease was found in 43%, reinforcing the role in planned re-TUR for high-risk patients in this setting. Future analysis with additional patients will increase the statistical power comparing these two groups. MP4-02 25