Pd13-09 clinical validation of the eau2021 intermediate risk nmibc definition and implications for adjuvant treatment: a multicenter yau urothelial collaboration

You have accessJournal of UrologyCME1 Apr 2023PD13-09 CLINICAL VALIDATION OF THE EAU2021 INTERMEDIATE RISK NMIBC DEFINITION AND IMPLICATIONS FOR ADJUVANT TREATMENT: A MULTICENTER YAU UROTHELIAL COLLABORATION Matteo Rosazza, Francesco Soria, Marco Moschini, Francesco Del Giudice, Renate Pichler, Rodolfo Hurle, Stefano Mancon, Diego M Carrion Monsalve, Wojciech Krajewski, Andrea Mari, Simone Mazzoli, Simone Livoti, Daniele Dutto, Matteo De Bellis, Luciano Ola, Francesca Pisano, Chiara Fiameni, Beatrice Lillaz, and Paolo Gontero Matteo RosazzaMatteo Rosazza More articles by this author , Francesco SoriaFrancesco Soria More articles by this author , Marco MoschiniMarco Moschini More articles by this author , Francesco Del GiudiceFrancesco Del Giudice More articles by this author , Renate PichlerRenate Pichler More articles by this author , Rodolfo HurleRodolfo Hurle More articles by this author , Stefano ManconStefano Mancon More articles by this author , Diego M Carrion MonsalveDiego M Carrion Monsalve More articles by this author , Wojciech KrajewskiWojciech Krajewski More articles by this author , Andrea MariAndrea Mari More articles by this author , Simone MazzoliSimone Mazzoli More articles by this author , Simone LivotiSimone Livoti More articles by this author , Daniele DuttoDaniele Dutto More articles by this author , Matteo De BellisMatteo De Bellis More articles by this author , Luciano OlaLuciano Ola More articles by this author , Francesca PisanoFrancesca Pisano More articles by this author , Chiara FiameniChiara Fiameni More articles by this author , Beatrice LillazBeatrice Lillaz More articles by this author , and Paolo GonteroPaolo Gontero More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003260.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recently, EAU Guidelines adopted a new risk-stratification model for NMIBC (EAU2021 scoring model), which was tested in an IPD analysis of 3041 primary NMIBC. Of these, only 54% were treated with adjuvant chemotherapy and may be not representative of current clinical practice. Moreover, using the EAU2021 model, some TaHG tumors should be classified as intermediate risk (IR). Consequently, the IR group now includes a broad spectrum of disease (Ta and T1 as well as LG and HG tumors) for whom treatment may vary from adjuvant chemotherapy with or without maintenance to intravesical BCG. Based on these considerations, the outcome of our study was to validate the homogeneity of IR group and to evaluate the most effective chemotherapy regimen for each subgroup of patients. METHODS: This was a multicenter collaboration involving 8 European referral Centers of the YAU Urothelial working group. Primary or recurrent NMIBC treated with intravesical chemotherapy and stratified as having IR disease according to the 2021 model were included. Main endpoint was RFS and PFS rates of the entire group, and of TaHG patients compared to other patients’ subgroups. Secondary endpoint was to evaluate the impact of maintenance chemotherapy on RFS and of PFS and to assess the best candidate for maintenance. KM curves were built to evaluate the risk of disease recurrence and progression and multivariable regression analyses to evaluate the impact of maintenance on RFS and PFS. The forest plot method was used to evaluate the subgroup of patients who benefit more from maintenance treatment. RESULTS: Overall, 610 patients were included. Of these, 228 (38%) and 382 (63%) were primary and recurrent NMIBC, respectively. TaHG, TaLG and T1LG were found in 113 (19%), 440 (72%) and 57 (9%) of patients. RFS rates varied from 83% at 1 yr and 50% at 5 yrs. PFS rates varied from 99% at 1 yr and 93% at 5 yrs. Oncological outcomes of TaHG patients did not differ from those of TaLG or T1LG disease. On multivariable analyses maintenance was associated with improved RFS (HR 0.57, p<0.001) but not with PFS (HR 0.83, p=0.7). Maintenance was particularly effective in preventing recurrence among TaHG patients. CONCLUSIONS: We externally validated the homogeneity of IR disease spectrum regarding oncological outcomes, and we confirmed that selected TaHG patients harbor the same oncological outcomes of other IR subgroups. In IR disease, adjuvant chemotherapy with maintenance should be indicated to lower the risk of disease recurrence, especially in patients with TaHG tumors. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e409 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matteo Rosazza More articles by this author Francesco Soria More articles by this author Marco Moschini More articles by this author Francesco Del Giudice More articles by this author Renate Pichler More articles by this author Rodolfo Hurle More articles by this author Stefano Mancon More articles by this author Diego M Carrion Monsalve More articles by this author Wojciech Krajewski More articles by this author Andrea Mari More articles by this author Simone Mazzoli More articles by this author Simone Livoti More articles by this author Daniele Dutto More articles by this author Matteo De Bellis More articles by this author Luciano Ola More articles by this author Francesca Pisano More articles by this author Chiara Fiameni More articles by this author Beatrice Lillaz More articles by this author Paolo Gontero More articles by this author Expand All Advertisement PDF downloadLoading ...