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<h5 class="section-title" id="d4077911e171">Background</h5>
<p id="P2">High-risk non–muscle-invasive bladder cancer (NMIBC) that invades into
the lamina
propria is frequently understaged and is associated with a risk of lymph node metastasis
and death.
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<h5 class="section-title" id="d4077911e176">Objective</h5>
<p id="P3">To identify high-risk features (HRFs) for NMIBC that may identify patients
with poorer
prognosis who may benefit from neoadjuvant chemotherapy (NAC) prior to radical cystectomy
(RC).
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<h5 class="section-title" id="d4077911e181">Design, setting, and participants</h5>
<p id="P4">We performed a single-center retrospective review of patients who underwent
RC for
NMIBC with invasion into the lamina propria between 1995 and 2013. HRFs included hydronephrosis,
abnormal examination under anesthesia, lymphovascular invasion, or variant histology.
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<h5 class="section-title" id="d4077911e186">Outcome measurements and statistical analysis</h5>
<p id="P5">Pathology at RC, and overall (OS) and disease-specific (DSS) survival were
evaluated
and analyzed by Fisher’s exact test, Student
<i>t</i> test, Cox proportional hazards regression analysis, and the Kaplan–Meier
method.
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<h5 class="section-title" id="d4077911e194">Results and limitations</h5>
<p id="P6">We identified 336 patients with a median follow-up of 130 mo. Of these,
159 (47%)
had no HRF, 140 (41.5%) had one HRF, and 37 (11%) had ≥2 HRFs. At RC, patients with
≥2 HRFs had a significantly higher rate of pathologic T stage upstaging and lymph
node metastasis (
<i>p</i> < 0.05). Median OS was 139 mo for those with no HRF, 127 mo for those
with one HRF,
and 56 mo for those with ≥2 HRF (
<i>p</i> = 0.0057). HRFs are also associated with a decreased DSS (
<i>p</i> = 0.0009). Patients with ≥2 HRFs (11/37) who received NAC showed improved
OS (21%
vs 55% 5-yr OS,
<i>p</i> = 0.0353) and trended toward an improvement in DSS (25% vs 56% 5-yr OS,
<i>p</i> = 0.0716) compared with RC alone.
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<h5 class="section-title" id="d4077911e214">Conclusions</h5>
<p id="P7">The presence of ≥2 HRFs in NMIBC invading the lamina propria is associated
with worse
pathology at RC and a significant decrease in OS and DSS. NAC appears to provide benefit
for these patients. Limitations include retrospective design and limited sample size.
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<h5 class="section-title" id="d4077911e219">Patient summary</h5>
<p id="P8">The presence of high-risk features in urothelial cancer with invasion into
the lamina
propria has a worse prognosis that may be mitigated by neoadjuvant chemotherapy.
</p>
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