PD42-12: Modeling the Contribution of Preoperative VI-RADS Score to Predict Final Pathologic Lymph-Nodes Involvement in Patients with MIBC Undergone Radical Cystectomy
Sunday, May 15, 2022
11:20 AM – 11:30 AM
Location: Room 245
Francesco Del Giudice*, Martina Pecoraro, Maurizio Del Monte, Marco Bicchetti, Emanuele Messina, Ailin Dehghanpour, Rome, Italy, Benjamin I. Chung, Stanford, CA, Ettore De Berardinis, Alessandro Sciarra, Carlo Catalano, Valeria Panebianco, Rome, Italy
Introduction: Muscle invasive bladder cancers (MIBCs) eligible for radical cystectomy (RC) are frequently associated with subsequent pathologic regional LN involvement (pN1-3). Involvement increases with the depth of invasion, thus preoperative tools aiming to predict final histology would assume particular relevance given that a significant subset of patients may be rendered long term disease free with surgery alone. We explored the ability of the novel Vesical-Imaging Reporting and Data System (VI-RADS) score to correlate with pN+ status and lymph node density (LNd) at RC pathology report.
Methods: Patients’ ineligible neoadjuvant chemotherapy who underwent multiparametric magnetic resonance imaging (mpMRI) of the bladder prior to staging trans-urethral resection of bladder tumor (TURBT) followed by RC and extended pelvic lymph-node dissection (ePLND) for cT2-4 N0 M0 MIBC. Multivariable logistic regression model and receiver operating characteristics curve (ROC) were used to asses VI-RADS features to predict final pN+ status and higher LNd.
Results: n=128 T2–T4a, cN0–M0 patients (VI-RADS Score 5, n= 39, Score 4, n=52, Score 3, n=37) were examined. pN+ rate was 27% with n=10 (7.8%), n=26 (20.3%) presenting with pN1 and pN2 respectively. Mean lymph node density (SD) was 9% (1.5%). Increasing VI-RADS score was independently associated with higher odd of LN+ status (OR, 1.79, 95%CI: 1.24 – 2.47). Moreover, VI-RADS score 5 presented an area under the curve (AUC) of 0.89 (95%CI: 0.74 – 0.96) for LNd threshold of 5.7% when compared to preoperative VI-RADS 3-4.
Conclusions: VI-RADS is a novel tool potentially able to preoperatively predict MIBCs at higher risk for presenting pN+ status at final RC histological report. In future VI-RADS could serve as a non-invasive method to aid urologists planning the extent of LN template thus balancing the benefit and morbidity of extended vs. limited LN dissection at the moment of RC.