ObjectiveTo assess 30‐ and 90‐day postoperative complication rates in patients who underwent robot‐assisted radical cystectomy (RARC) after receiving novel immunotherapy‐based neoadjuvant treatment.MethodsA bi‐centre analysis was conducted in patients who underwent RARC with intracorporeal urinary diversion and who received an immunotherapy‐based neoadjuvant regimen between 2017 and 2023. Complications were classified using the Clavien–Dindo system.ResultsThe cohort included 136 patients, with a median (interquartile range [IQR]) age of 66 (61–73) years, of whom 22 were female (16.2%). The overall 30‐day and 31–90‐day Clavien–Dindo grade ≥3a complication rates were 15.4%, and 14.7%, respectively. The most common cumulative 90‐day complications by category were infectious (59.6%), genitourinary (33.1%), and gastrointestinal (22.7%). The median (IQR) hospital stay was 11 (7–16) days, and 36 patients (26.5%) required readmission. Eighty‐four patients received monotherapy with an immune checkpoint inhibitor and 52 received combination immunochemotherapy. A higher rate of 30‐day infectious complications was seen in the immuno‐monotherapy group (46.4% vs 26.9%; P = 0.03), while pulmonary complications were more commonly reported in the combination immunochemotherapy group (9.6% vs 1.2%; P = 0.03). No statistically significant differences were found in the other complication categories between the groups. Eleven patients (8.1%) experienced 13 (9.6%) immune‐related adverse events (irAEs). The most common irAEs were hypothyroidism and dermatitis.ConclusionsThe cumulative 90‐day complication rate after novel immunotherapy‐based neoadjuvant treatment appears higher than those previously reported for RARC alone or for chemotherapy‐based neoadjuvant regimens. We observed irAEs in 8.1% of patients after RARC, highlighting the need for urologists to recognise such events.

Representativeness of study participants

Distribution of the GSC subtypes according to the TCGA classification.

Updated adverse events observed in ITT population

INTRODUCTION:Until recently there was no recommended adjuvant therapy for patients with lymph nodes metastasis (ypN+) following neoadjuvant chemotherapy (NAC) and radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC). The aim of the study was to describe the oncological outcomes of ypN+ patients following NAC and RC for MIBC. METHODS:This collaborative retrospective study included 195 patients with ypN+ disease after NAC followed by RC and bilateral pelvic lymph node dissection for MIBC between 2000 and 2019 in seven centers. Patients' demographics, clinical and pathological features were collected. Survival analyses were carried out with Kaplan-Meier estimates and a Cox model was generated. RESULTS:A total of 120 patients (62%) were pN1, 51 pN2 (26%) and 24 pN3 (12%). Adjuvant radiation therapy was performed in 18 (9%), adjuvant chemotherapy in 40 (21%) and the remaining 137 (70%) patients were observed. The median follow-up time was 51 months (95%CI 44-62). Median times for recurrence-free survival, cancer-specific survival and overall survival (OS) were 18 months (95%CI 16-21), 47 months (95%CI 31-70) and 28 months (95%CI 22-34) respectively. On multivariable analysis, female gender (HR = 1.5, 95%CI 1.002-2.21, p = 0.049) and positive surgical margins (HR = 1.6, 95%CI 1.06-2.38, p = 0.026) were the only independent predictor of OS. The type of adjuvant therapy did not impact OS (adjuvant chemotherapy, p = 0.44; adjuvant radiotherapy p = 0.40). CONCLUSION:MIBC patients with residual node positive disease following NAC and RC have poor survival outcomes. Females and patients with positive margin status at RC carry a poorer prognosis. These results may be beneficial for clinical trial design.

Background and objective Data about the mid- and long-term oncologic outcomes of endoscopic kidney-sparing surgery (eKSS) for upper tract urothelial carcinoma (UTUC) are scarce. Therefore, we aimed to summarize the current evidence on the oncologic outcomes of eKSS for UTUC. Methods A literature search was conducted to identify reports published until May 2024. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed to identify eligible studies. The outcomes were the following: recurrence-free (RFS), intravesical recurrence-free (IV-RFS), progression-free (PFS), cancer-specific (CSS), and overall (OS) survival. Key findings and limitations We found 56 studies (n = 52 retrospective) that met our inclusion criteria (n = 2862 patients). The 1-, 2-, 5-, and 10-yr OS rates were 96%, 87%, 80%, and 42%, respectively. The 1-, 2-, 5-, and 10-yr CSS rates were 97%, 89%, 82%, and 69%, respectively. RFS rates at 1, 2, and 5 yr were 69%, 55%, and 45%, respectively. IV-RFS rates at 1, 2, and 5 yr were 80%, 65%, and 64%, respectively. PFS rates at 2 and 5 yr were 75% and 69%, respectively. In low-grade UTUC, OS rates at 2 and 5 yr were 93% and 77%, respectively. The 2- and 5-yr CSS rates were 98% and 88%, respectively. At 2 yr, RFS, IV-RFS, and PFS were 52%, 54%, and 94%, respectively. For high-grade UTUC, only three studies reported data on 2-yr RFS, which was 34%. The main limitation is the heterogeneity found across the studies. Conclusions and clinical implications Local recurrence, bladder recurrence, and progression of UTUC occur mainly within 2 yr after eKSS. After 5-yr follow-up, OS and CSS drop, while the risk of local recurrence is non-negligible.

Surgical safety outcomes in PURE-01 trial

Supplementary Figure 1: Study flow-chart. Supplementary Figure 2: Kaplan-Meier curves of event-free survival according to tertile-split tumor mutational burden. Supplementary Figure 3. Kaplan-Meier curves of recurrence-free survival according to the molecular subtype. Supplementary Figure 4: PD-L1 staining values (CPS percentages) according to molecular subtypes, split by the three subtyping classifiers GSC/Decipher, Consensus classification, and TCGA.

BACKGROUND AND OBJECTIVE:Given the uncertainty regarding the role of radical nephroureterectomy (RNU) as part of a multimodal treatment strategy for upper tract urothelial carcinoma (UTUC) patients with cN+ disease, we aimed to perform a systematic review and meta-analysis of the corresponding literature. METHODS:Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we identified 17 observational comparative and noncomparative studies, published between January 2000 and September 2024, evaluating UTUC patients with cTanyN+M0 disease (P) who received RNU as part of a multimodal treatment strategy (I), as compared with any treatment strategy if applicable (C), to assess oncological or postoperative outcomes (O). Meta-analyses were further performed, as appropriate. KEY FINDINGS AND LIMITATIONS:Overall, 15 studies evaluated the effectiveness of adding chemotherapy to RNU in the perioperative setting without specifying the exact timing of delivery (n = 1), in the induction setting (n = 14), or in the adjuvant setting (n = 5), while two studies evaluated the effectiveness of adding RNU to chemotherapy. Meta-analyses showed that the use of induction chemotherapy plus RNU versus RNU alone was associated with greater odds of pathological downstaging (risk ratio [RR] = 3.06; 95% confidence interval [CI] = [2.48-3.77]; p < 0.001; I2 = 0%; p = 0.44) and pathological complete nodal response (RR = 2.80; 95% CI = [2.03-3.86]; p < 0.001; I2 = 0%; p = 0.47) as well as prolonged overall survival (HR = 0.52; 95% CI = [0.42-0.64]; p < 0.001; I2 = 14%; p = 0.33) without any significant impact on the risk of overall (RR = 1.14; 95% CI = [0.79-1.64]; p = 0.48; I2 = 0%; p = 0.76) and major (RR = 0.48; 95% CI = [0.18-1.24]; p = 0.13; I2 = 0%; p = 0.87) postoperative complications. In addition, the use of induction chemotherapy plus RNU versus RNU plus adjuvant chemotherapy (HR = 0.58; 95% CI = [0.38-0.89]; p = 0.01) or chemotherapy alone (HR = 0.49; 95% CI = [0.32-0.76]; p = 0.001; I2 = 46%; p = 0.17) was associated with prolonged overall survival. Limitations include the observational design of all included studies. CONCLUSIONS AND CLINICAL IMPLICATIONS:The use of RNU could provide the greatest oncological benefits without any significant harm in selected UTUC patients with fit general condition and resectable cN+ disease responding to induction chemotherapy. PATIENT SUMMARY:In this report, we looked at the outcomes of radical surgery in combination with systemic chemotherapy for upper tract urothelial carcinoma with clinical evidence of dissemination to the surrounding lymph nodes. We observed that the use of radical surgery was associated with the greatest oncological benefits without any increased risk of postoperative complications in patients with fit general condition and resectable disease responding to induction chemotherapy. We conclude that the use of induction chemotherapy plus radical surgery could be the best multimodal treatment strategy for these patients.

Distribution of the GSC subtypes according to the Consensus Bladder Cancer classification.

Background and objective Bacillus Calmette-Guérin (BCG) reduces disease recurrence and progression in intermediate- and high-risk non–muscle-invasive bladder cancer (NMIBC). BCG-associated adverse events during instillations are common, leading to treatment cessation. Prophylactic use of quinolones in conjunction with BCG instillations is one approach for reducing BCG-associated adverse events. Our aim was to delineate the clinical impact of quinolone prophylaxis (QP) in patients receiving adjuvant BCG instillations for NMIBC. Methods In October 2024, a systematic search of MEDLINE, Embase, and the Cochrane Central Register of controlled trials was performed. Prospective and retrospective studies reporting comparative outcomes for patients with and without QP during BCG instillations were included. Outcomes were reported in a binary fashion. Random-effects meta-analysis using the weighted mean difference was conducted. Primary outcomes for pooled analyses included BCG-associated toxicities, the completion rate for BCG induction, the likelihood of antituberculosis treatment, and disease recurrence and progression at 12 mo. Key findings and limitations The systematic review included five studies. Four randomised controlled trials were included in the meta-analysis, and one nonrandomised study was also included in the narrative review. The studies involved 445 patients, of whom 194 received QP + BCG and 251 received BCG alone. QP use was associated with lower incidence of class ≥2 (40.8% vs 54.7%; relative risk [RR] 0.79, 95% confidence interval [CI] 0.67–0.94; p = 0.006), and class ≥3 BCG-associated toxicities (25.3% vs 36.4%; RR 0.70, 95% CI 0.50–0.98; p = 0.04) and a higher completion rate for BCG induction (83.0% vs 70.6%; RR 1.16, 95% CI 1.01–1.34; p = 0.04). The 12-mo recurrence rates (14.7% vs 19.4%; RR 0.76, 95% CI 0.46–1.27; p = 0.3) and progression rates (4.5% vs 6.4%; RR 0.86, 95% CI 0.09–8.25; p = 0.9) did not significantly differ for QP + BCG versus BCG alone. Conclusions and clinical implications The use of QP with adjuvant BCG for NMIBC mitigated debilitating BCG-associated toxicities and improved the completion rate for BCG induction therapy.

Abstract Recent phase 3 randomized controlled trials (RCTs) demonstrate the promising impact of immune checkpoint inhibitor (ICI)-based combination therapies on locally advanced or metastatic urothelial carcinoma (UC). However, comparative data on the efficacy and toxicity of different ICI-based combinations are lacking. This study aims to compare the efficacy of first-line ICI-based combination therapies for locally advanced or metastatic UC using phase 3 RCT data. In November 2023, three databases were searched for RCTs evaluating oncological outcomes in patients with locally advanced or metastatic UC who were treated with first-line ICI-based combination therapies. Network meta-analysis (NMA) was conducted to compare outcomes, including overall survival (OS), progression-free survival (PFS), objective response rates (ORRs), complete response rates (CRRs), and treatment-related adverse events (TRAEs). Subgroup analyses were based on PD-L1 status and cisplatin eligibility. The NMA included five RCTs. Enfortumab vedotin (EV) + pembrolizumab ranked the highest for improving OS (100%), PFS (100%), ORR (96%), and CRR (96%), followed by nivolumab + chemotherapy. EV + pembrolizumab combination superiority held across PD-L1 status and cisplatin eligibility. In patients who are cisplatin-eligible, EV + pembrolizumab significantly improved OS (HR: 0.68, 95%CI 0.47–0.99) and PFS (HR: 0.67, 95%CI 0.49–0.92) compared to nivolumab + chemotherapy. Durvalumab + tremelimumab was the safest combination for severe TRAEs, and EV + pembrolizumab ranked second. Our analyses support EV + pembrolizumab combination as a first-line treatment for locally advanced or metastatic UC. Thus, EV + pembrolizumab may become a guideline-changing standard treatment.

You have accessJournal of UrologyProstate Cancer: Staging II (PD45)1 May 2024PD45-05 WHEN DOES SYSTEMATIC BIOPSY INFORMATION MATTER THE MOST? IDENTIFYING INDEPENDENT PREDICTORS OF DISEASE DOWNGRADING AT RADICAL PROSTATECTOMY IN HIGH GRADE PROSTATE CANCER BASED ON A LARGE MULTI-INSTITUTIONAL SERIES Gabriele Sorce, Armando Stabile, Mattia Longoni, Pietro Scilipoti, Guillaume Ploussard, Giancarlo Marra, Massimo Valerio, Riccardo Campi, Andrea Minervini, Sergio Serni, Marco Moschini, Alessandro Marquis, Jean Baptiste Beauval, Arnas Rakauskas, Roderick van den Bergh, Razvan-George Rahota, Timo F. W. Soeterik, Mathieu Roumiguié, Hongqian Guo, Agostino Mattei, Paolo Gontero, Giorgio Gandaglia, Francesco Montorsi, and Alberto Briganti Gabriele SorceGabriele Sorce , Armando StabileArmando Stabile , Mattia LongoniMattia Longoni , Pietro ScilipotiPietro Scilipoti , Guillaume PloussardGuillaume Ploussard , Giancarlo MarraGiancarlo Marra , Massimo ValerioMassimo Valerio , Riccardo CampiRiccardo Campi , Andrea MinerviniAndrea Minervini , Sergio SerniSergio Serni , Marco MoschiniMarco Moschini , Alessandro MarquisAlessandro Marquis , Jean Baptiste BeauvalJean Baptiste Beauval , Arnas RakauskasArnas Rakauskas , Roderick van den BerghRoderick van den Bergh , Razvan-George RahotaRazvan-George Rahota , Timo F. W. SoeterikTimo F. W. Soeterik , Mathieu RoumiguiéMathieu Roumiguié , Hongqian GuoHongqian Guo , Agostino MatteiAgostino Mattei , Paolo GonteroPaolo Gontero , Giorgio GandagliaGiorgio Gandaglia , Francesco MontorsiFrancesco Montorsi , and Alberto BrigantiAlberto Briganti View All Author Informationhttps://doi.org/10.1097/01.JU.0001008792.09108.b4.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Discordance between initial biopsy results and subsequent radical prostatectomy (RP) specimen pathology for ISUP 4-5 patients is substantial even relying on the most contemporary combined mpMRI targeted (TBx) and systematic biopsy (SBx) diagnostic pathway, leading to challenges in risk stratification. While most studies have examined downgrading rates, they often overlook their clinical significance, leaving the factors influencing downgrading largely unexplored. We aimed to investigate rates of clinically significant downgrading and identify independent predictors. METHODS: We identified 356 patients with complete data treated with RP at ten tertiary referral centers (2014-2022), with a positive mpMRI and prostate cancer (PCa) ISUP 4-5 detected via SBx plus TBx. The outcome was a clinically significant PCa downgrading, defined as an ISUP 4-5 at biopsy to a lower ISUP (1-3) at RP. Multivariable logistic regression models (MVA) were fitted to identify independent predictors of downgrading using the following covariates: PSA, pattern Gleason score patterns at SBx and TBx, index lesion (IL) diameter, and SBx and TBx core ratios. The accuracy was quantified using the area under the receiver-operating curve (AUC). RESULTS: Overall, 155 (44%) patients exhibited clinically significant downgrading at RP. In total, 192 (54%) demonstrated concordant ISUP results at both SBx and TBx, while 95 (27%) exhibited higher ISUP scores at TBx, and 69 (19%) had higher ISUP scores at SBx. Of those groups, 58 (30%), 56 (59%), and 41 (59%) exhibited downgrading at RP, respectively. At MVA, patients with discordant ISUP at both SBx and TBx (OR: 3.44) and Gleason grade pattern 4+4 (OR: 3.77) were more likely to exhibit downgrading at RP (all p<0.001). Moreover, patients with larger IL (OR: 0.94, p=0.02) were less likely to exhibit downgrading at RP. The inclusion of SBx information to TBx core ratios increase the accuracy of the model from 0.76 to 0.78. CONCLUSIONS: We found that 44% of men with high risk disease at biopsy experienced clinically significant downgrading to lower Gleason score at RP. Patients with discordant ISUP at SBx vs TBx and without Gleason pattern 5 have higher risk of disease downgrading. Thus, in this subset of men if systematic biopsy was not performed, a significant risk of overtreatment such as long-term androgen deprivation therapy (ADT) instead of shorter ADT administration for those candidates to radiation therapy would exist. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e969 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Gabriele Sorce More articles by this author Armando Stabile More articles by this author Mattia Longoni More articles by this author Pietro Scilipoti More articles by this author Guillaume Ploussard More articles by this author Giancarlo Marra More articles by this author Massimo Valerio More articles by this author Riccardo Campi More articles by this author Andrea Minervini More articles by this author Sergio Serni More articles by this author Marco Moschini More articles by this author Alessandro Marquis More articles by this author Jean Baptiste Beauval More articles by this author Arnas Rakauskas More articles by this author Roderick van den Bergh More articles by this author Razvan-George Rahota More articles by this author Timo F. W. Soeterik More articles by this author Mathieu Roumiguié More articles by this author Hongqian Guo More articles by this author Agostino Mattei More articles by this author Paolo Gontero More articles by this author Giorgio Gandaglia More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement PDF downloadLoading ...

ObjectivesTo assess the risk of venous thromboembolic events (VTEs) and bleeding with or without thromboprophylaxis during neoadjuvant chemotherapy in bladder cancer patients scheduled for radical cystectomy.Materials and MethodsWe conducted a retrospective cohort study in 4886 patients with non‐metastatic bladder cancer undergoing cystectomy across 28 centres in 13 countries between 1990 and 2021. Inverse probability weighting analyses were performed to estimate the effect of thromboprophylaxis on VTE and bleeding.ResultsIn 147 patients (3%) VTEs were recorded within the first year. These occurred a median (interquartile range [IQR]) of 127 (82–198) days after bladder cancer diagnosis. Bleeding events occurred in 131 patients (3%) within the first year. These occurred a median (IQR) of 101 (83–171) days after cancer diagnosis. In inverse probability weighting analyses, compared to patients without thromboprophylaxis during chemotherapy, patients with thromboprophylaxis had not only a lower risk of VTE (hazard ratio [HR] 0.32, 95% confidence interval [CI] 0.12–0.81; P = 0.016) but also a lower bleeding risk (HR 0.03, 95% CI 0.09–0.12; P <0.0001). The retrospective nature of the study was its main limitation.ConclusionsIn this retrospective analysis, the benefit of thromboprophylaxis during neoadjuvant chemotherapy before cystectomy is in line with data from randomised trials in other malignancies. Our data suggest thromboprophylaxis is protective against VTEs and should be the standard of care during neoadjuvant chemotherapy.

OBJECTIVE:To conduct a population-based study examining cancer-specific mortality (CSM) and other-cause mortality (OCM) differences in patients with radiation-induced secondary bladder cancer (RT-BCa) vs those with primary bladder cancer (pBCa) undergoing radical cystectomy (RC). METHODS:Within the Surveillance, Epidemiology, and End Results database (2004-2020), we identified patients with T2-4N0-3M0 bladder cancer treated with RC, who had previously been treated with external beam radiation therapy (EBRT) or brachytherapy for prostate cancer, as well as patients with T2-4N0-3M0 pBCa treated with RC. Cumulative incidence plots and multivariable competing risks regression (CRR) models were used to assess CSM after additional adjustment for OCM. The same methodology was then repeated based on organ-confined (OC: T2N0M0) and non-organ-confined (NOC: T3-4 and/or N1-3) disease. RESULTS:Of 9957 RC patients, RT-BCa was identified in 347 (3%) compared with 9610 (97%) who had pBCa. In multivariable CRR models, no CSM differences were recorded in the overall comparison (P = 0.8), nor in sub-groups based on OC and NOC disease (P = 0.8 and 0.7, respectively). Conversely, multivariable CRR models identified RT-BCa as an independent predictor of 1.3-fold higher OCM in the overall cohort and of 1.5-fold higher OCM in those with NOC disease. In a sensitivity analysis of patients with NOC disease, EBRT was associated with higher OCM rates (hazard ratio 1.5). By contrast, OCM rates were not different in those with OC disease (P = 0.8). CONCLUSION:Our study showed that RC for RT-BCa was associated with similar CSM rates as RC for pBCa, regardless of disease stage. However, patients who had undergone EBRT exhibited significantly higher OCM in the NOC sub-group.

You have accessJournal of UrologyBladder Cancer: Non-invasive IV (MP71)1 May 2024MP71-15 CANCER CONTROL RATES IN ADEQUATE VERSUS INADEQUATE TREATMENT WITH ADJUVANT IMMUNOTHERAPY INSTILLATIONS WITH BCG Mario de Angelis, Giuseppe Basile, Pietro Scilipoti, Mattia Longoni, Chiara Re, Giulio Avesani, Riccardo Leni, Daniele Robesti, Alessandro Bertini, Leonardo Quarta, Giusy Burgio, Giuseppe Rosiello, Andrea Necchi, Daniele Raggi, Roberta Lucianò, Giorgio Gandaglia, Umberto Capitanio, Renzo Colombo, Andrea Salonia, Francesco Montorsi, Alberto Briganti, and Marco Moschini Mario de AngelisMario de Angelis , Giuseppe BasileGiuseppe Basile , Pietro ScilipotiPietro Scilipoti , Mattia LongoniMattia Longoni , Chiara ReChiara Re , Giulio AvesaniGiulio Avesani , Riccardo LeniRiccardo Leni , Daniele RobestiDaniele Robesti , Alessandro BertiniAlessandro Bertini , Leonardo QuartaLeonardo Quarta , Giusy BurgioGiusy Burgio , Giuseppe RosielloGiuseppe Rosiello , Andrea NecchiAndrea Necchi , Daniele RaggiDaniele Raggi , Roberta LucianòRoberta Lucianò , Giorgio GandagliaGiorgio Gandaglia , Umberto CapitanioUmberto Capitanio , Renzo ColomboRenzo Colombo , Andrea SaloniaAndrea Salonia , Francesco MontorsiFrancesco Montorsi , Alberto BrigantiAlberto Briganti , and Marco MoschiniMarco Moschini View All Author Informationhttps://doi.org/10.1097/01.JU.0001009548.76580.ba.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Current guidelines recommend adjuvant bacillus Calmette-Guérin (BCG) immunotherapy for the treatment of intermediate risk (IR) and high-risk (HR) non-muscle invasive bladder cancer (NMIBC). However, optimal response to BCG is associated with an adequate treatment according to international guidelines. We investigated the impact of inadequate treatment on the risk of recurrence and progression. METHODS: We identified 311 patients treated with transurethral resection of bladder tumor (TURBT) and diagnosed with IR and HR NMIBC in a tertiary referral centre between 2012 and 2020. Patients were divided according to adequateness of BCG treatment, defined as at least five of six instillations of induction and at least two of three instillations of maintenance, as recommended by the International Bladder Cancer Group (IBCG). Endpoint of our study was to estimate the 5-year recurrence-free survival (RFS) and 5-year progression-free survival (PFS) among patients who received adequate vs inadequate BCG therapy. Kaplan-Meyer analysis (KM) and multivariable Cox-regression (MCR) models were fitted to test the effect of BCG treatment adequateness. RESULTS: Overall, 133 (43%) patients received an inadequate treatment according to IBCG. During a median follow-up of 35 months (IQR: 19,60), 98 (31.5%) patients experienced a disease recurrence, of which 50 (51%) were treated adequately vs. 48 (49%) who were not (p=0.1). Similarly, 25 patients (8%) showed a progression to muscle-invasive disease, of which 14 (56%) were not treated adequately (p=0.2). Five-year RFS estimates were 72.3% in those who received adequate treatment vs. 58.3% in those who did not (Δ=14%, p=0.02). In MCR models, inadequate treatment independently predicted disease recurrence (HR: 2.2, 95%CI: 1.327, 3.917,p=0.003), after adjusting for age, EAU risk category, eventual concomitant carcinoma in situ at first TURBT and eventual second look. Similarly, adequately treated patients have a lower five-year PFS compared to their counterparts (90.1% vs. 86.3%, respectively,p=0.04). CONCLUSIONS: Patients with adequate BCG treatment according to IBCG have a lower risk of recurrence and progression relative to those treated inadequately. Thus, patients unable to receive adequate BCG instillations have lower cancer control rates and are more likely to undergo RC. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1166 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Mario de Angelis More articles by this author Giuseppe Basile More articles by this author Pietro Scilipoti More articles by this author Mattia Longoni More articles by this author Chiara Re More articles by this author Giulio Avesani More articles by this author Riccardo Leni More articles by this author Daniele Robesti More articles by this author Alessandro Bertini More articles by this author Leonardo Quarta More articles by this author Giusy Burgio More articles by this author Giuseppe Rosiello More articles by this author Andrea Necchi More articles by this author Daniele Raggi More articles by this author Roberta Lucianò More articles by this author Giorgio Gandaglia More articles by this author Umberto Capitanio More articles by this author Renzo Colombo More articles by this author Andrea Salonia More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Marco Moschini More articles by this author Expand All Advertisement PDF downloadLoading ...

Background An accurate method of assessing the response of muscle-invasive bladder cancer (MIBC) to neoadjuvant treatment is needed for selecting candidates for bladder-sparing strategies. Purpose To evaluate the diagnostic accuracy and reproducibility of neoadjuvant chemotherapy Vesical Imaging Reporting and Data System (nacVI-RADS) scores and posttreatment Vesical Imaging Reporting and Data System (VI-RADS) scores when assessing MIBC response to neoadjuvant immunotherapy with multiparametric MRI (mpMRI). Materials and Methods A retrospective analysis of MRI scans was conducted in patients enrolled in the PURE-01 study (NCT02736266) from February 2017 to December 2019 who underwent pre- and postimmunotherapy mpMRI before radical cystectomy. Five readers independently reviewed the scans using VI-RADS and nacVI-RADS criteria. Diagnostic accuracy was evaluated for each reader, and the final histopathologic diagnosis served as the reference standard. Interreader agreement was assessed with the percentage of agreement, Conger κ, and Gwet agreement coefficient AC1. Results A total of 110 patients (median age, 67 years [IQR: 61-74]; 96 male) with 220 MRI scans were included; 80 (73%) patients had pure urothelial carcinoma. A total of 46 of 110 (42%) patients achieved a complete pathologic response. The sensitivity, specificity, and negative predictive value of nacVI-RADS 3 or higher for detecting residual disease (higher than stage ypT0) at radical cystectomy were 67%-84%, 63%-96%, and 63%-75%, respectively; for residual muscle-invasive disease (higher than stage ypT1), these values were 91%-98%, 55%-94%, and 93%-98%, respectively. The accuracy of nacVI-RADS was 72%-81% for stage ypT0 or higher disease and 71%-95% for stage ypT1 or higher disease. The accuracy of VI-RADS 3 or higher was 80%-95% for stage ypT1 or higher disease. The percentage of agreement for nacVI-RADS scores was 82% (κ = 0.62-0.65; AC1 = 0.65). Conclusion The nacVI-RADS scores showed good accuracy and reproducibility when assessing MIBC response to neoadjuvant immunotherapy. © RSNA, 2024 Supplemental material is available for this article.