1008 PARTIAL CYSTECTOMY DOES NOT UNDERMINE CANCER CONTROL IN APPROPRIATELY SELECTED PATIENTS WITH UROTHELIAL CARCINOMA OF THE BLADDER: A POPULATION-BASED MATCHED ANALYSIS

457 Background: Squamous differentiation is found in up to 60% of patients with urothelial carcinoma of the bladder. There is conflicting evidence regarding clinical relevance of aberrant urothelial differentiation as both population-based and retrospective studies have supported and refuted its correlation with poor prognosis and advanced stage in multivariate models. The biology of these tumors is poorly understood but some suggest that extensive squamous differentiation may resemble pure squamous tumors with similar responses to chemotherapy, radiation, and higher rate of local recurrence. Our aim was to compare tumors with squamous differentiation with those of pure urothelial histology at the genomic level to better elucidate targetable differences. Methods: We reviewed pathology reports for 412 patients with urothelial carcinoma from TCGA to identify patients with any amount squamous differentiation. Copy number alteration data obtained via the GISTC algorithm was downloaded from cbioportal.com. Chi square analysis was used to compare chromosomal amplifications in samples with squamous differentiation compared with samples that had no amount of variant histology. Results: 50 patients (12%) had some squamous differentiation, of which 15 commented on the percent of involvement – on average, 17% of the sample had squamous differentiation. A total of 257 (62%) of patients had no variant histology. Multiple specific sites in the 3q21-26 chromosomal region were noted to be amplified in squamous histology compared with pure urothelial carcinoma. Specific genes found to be amplified included SOX2 and PIK3. Conclusions: Amplifications of chromosome 3q21-25 were enriched in patients with squamous differentiation compared to those with pure urothelial carcinoma of the bladder. Amplification of this region has been reported in squamous transformation in multiple sites, including lung cancer. This study shows that, similar to other cancers, SOX2 may be necessary for squamous transformation. Furthermore, squamous cancer, which has traditionally though to be chemo-resistant, may respond to agents that target amplifications of genes found on the long arm of chromosome 3 including the PIK3-Akt pathway.

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Partial Cystectomy for Muscle Invasive Urothelial Carcinoma of the Bladder: A Contemporary Review of the M. D. Anderson Cancer Center Experience

The Journal of Urology ◽

10.1016/s0022-5347(06)00322-3 ◽

2006 ◽

Vol 175 (6) ◽

pp. 2058-2062 ◽

Cited By ~ 88

Author(s):

Wassim Kassouf ◽

David Swanson ◽

Ashish M. Kamat ◽

Dan Leibovici ◽

Arlene Siefker-Radtke ◽

...

Keyword(s):

Urothelial Carcinoma ◽

Partial Cystectomy ◽

Cancer Center ◽

Carcinoma Of The Bladder ◽

Muscle Invasive

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Partial cystectomy for urothelial carcinoma of the bladder: Practice patterns and outcomes in the general population

Canadian Urological Association Journal ◽

10.5489/cuaj.4403 ◽

2017 ◽

Vol 11 (12) ◽

pp. 412-8 ◽

Cited By ~ 1

Author(s):

Michael J. Leveridge ◽

D. Robert Siemens ◽

Jason P. Izard ◽

Xuejiao Wei ◽

Christopher M. Booth

Keyword(s):

Urothelial Carcinoma ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Partial Cystectomy ◽

Cox Proportional Hazards Model ◽

Factors Affecting ◽

Hazards Model ◽

Carcinoma Of The Bladder ◽

Longterm Survival

Introduction: Partial cystectomy (PC) for urothelial carcinoma (UC) in selected patients may avoid the morbidity of radical cystectomy (RC). We describe use and outcomes of PC for UC in routine clinical practice.Methods: All patients with urothelial carcinoma of the bladder (UCB) undergoing PC or RC in Ontario from 1994‒2008 were identified using the Ontario Cancer Registry and linked electronic records. Pathology reports were reviewed. Variables associated with PC use were identified using logistic regression. Cox proportional hazards model identified factors affecting cancer-specific (CSS) and overall survival (OS).Results: A total of 3320 patients underwent PC (n=181; 5%) or RC (n=3139; 95%) from 1994‒2008. PC patients were older (36% 80+ years vs. 19%; p<0.001) and more likely to have organ-confined (&lh;pT3) disease (54% vs. 36% RC; p<0.001). Two-thirds (67%) of PC patients did not undergo lymph node dissection (24% for RC; p<0.001). Factors associated with having PC included older age (odds ratio [OR] 1.55; 95% confidence interval [CI] 0.96‒2.51 for 70+ years), moderate comorbidity (OR 1.95; 95% CI 1.13‒3.37), and surgery outside of a comprehensive cancer centre (OR 1.44; 95% CI 1.03‒2.01). Unadjusted five-year OS for PC and RC cases was 34% and 33%, respectively (p=0.455); CSS at five years was 43% and 37% (p=0.045). On adjusted analysis, PC was associated with comparable CSS (hazard ratio [HR] 0.87, 95% CI 0.70‒1.09) and OS (HR 0.95, 95% CI 0.79‒1.14) as RC.Conclusions: In routine clinical practice, PC is not common. A substantial proportion of patients treated with PC achieve longterm survival. PC remains a treatment option in selected patients with UCB.

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