scholarly journals Malignancy Trends in HIV-Infected Patients Over the Past 10 Years in a Single-Center Retrospective Observational Study in the United States

2018 ◽  
Vol 25 (1) ◽  
pp. 107327481879795 ◽  
Author(s):  
Nancy Rihana ◽  
Sowmya Nanjappa ◽  
Cara Sullivan ◽  
Ana Paula Velez ◽  
Narach Tienchai ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Hodgkin Lymphoma ◽  
Anal Cancer ◽  
Invasive Cervical Cancer ◽  
Human Herpesvirus ◽  
Kaposi Sarcoma ◽  
Retrospective Chart Review ◽  
The United States ◽  
Cancer Center ◽  
Non Hodgkin Lymphoma

The introduction of antiretroviral therapy (ART) in 1995 had a dramatic impact on the morbidity and mortality of the HIV population, and subsequently, the natural history of cancer has changed. The purpose of our study was to review the prevalence of AIDS-defining malignancies and non-AIDS defining cancers (NADC), taking into consideration racial and gender variations. After the institutional review board approval, the study was conducted as a retrospective chart review of 279 HIV-infected patients who were treated at the Moffitt Cancer Center between January 1, 2000 and December 31, 2010. The demographic characteristics included gender, ethnicity, race, presence or absence of ART, and the type of malignancy reviewed. Of 233 men, 78 (33.5%) had AIDS-defining malignancies. AIDS-related non-Hodgkin lymphoma (NHL) was detected in 49 (21%) patients and Kaposi sarcoma (KS) in 29 (12%) patients. Two-thirds of male patients had NADC, with anal cancer being the most prevalent (8.5%), followed by Hodgkin lymphoma (6%). AIDS-related NHL was also the predominant malignancy for women with a prevalence of 19.5% followed by invasive cervical cancer (ICC) and breast cancer, both with a similar prevalence of 11%. Kaposi sarcoma and anal cancer were equally detected in 2% of women. The prevalence rates of AIDS-defining malignancies among those of white race were 34%, ranging from 21% for NHL to 13% for KS and 1.5% for ICC. Twenty-one (7.7%) patients had anal cancer. AIDS-defining malignancies were found in 36% of patients of black race and 60% had NHL. Non-AIDS-related NHL was the second most common malignancy, followed by breast cancer and anal cancer with a similar prevalence of 6.5%. Of 279 patients, 53% were taking ART; 39.4% were not taking ART; and in 7.5% of the patients, it was unknown if they were taking ART. In the ART era, our study found NADC to be more prevalent than AIDS-defining malignancies with 60% versus 40%, respectively. Non-Hodgkin lymphoma remained the most common AIDS-related malignancy in both genders. Among the patients with NADC, anal cancer was the predominant malignancy. The increasing incidence of some of the NADC is expected as this population is living longer with chronic exposure of viral replication of virus with oncogenic potential such as Human papillomavirus (HPV), Hepatitis B virus (HBV), Epstein-Barr virus (EBV), and Human herpesvirus 8 (HHV-8). Early ART initiation, aggressive vaccination, and judicious cancer screening are the cornerstone of cancer prevention of this growing population.

HIV associated cancers.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18254-e18254
Author(s):  
Prabhjot Singh Bedi ◽  
Manoj P. Rai ◽  
Fawzi Abu Rous ◽  
Rohanlal Vishwanth ◽  
Nishraj Basnet ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Logistic Regression ◽  
Head And Neck Cancer ◽  
Skin Cancer ◽  
Head And Neck ◽  
Hodgkin Lymphoma ◽  
Anal Cancer ◽  
Kaposi Sarcoma ◽  
P Value ◽  
Non Hodgkin Lymphoma

e18254 Background: The incidence or the prevalence of AIDS-defining cancers has reduced drastically (70% or more in the United States) since the introduction of three-drug antiretroviral therapy (ART) in the mid-1990s. However, the data from the inpatient sample is lacking. Methods: This is a retrospective analysis using data from the 2014 National Inpatient Sample database. We identified patients with either primary or secondary diagnosis of human immunodeficiency virus (HIV). Then we identified patients with various cancers including AIDS-defining cancers. Afterward, we ran logistic regression to check the degree of association between the diagnosis of each cancer with the diagnosis of HIV during the identified hospitalizations. We also assessed the prevalence of each of the cancer among the identified HIV patients, as well as the mortality in this cohort. Results: A total of 115955 hospitalizations with a diagnosis of HIV were identified. Among them, there were 6985 hospitalizations with Non-Hodgkin lymphoma, 2230 with rectal and anal cancer, 1170 with Kaposi sarcoma, 870 with head and neck cancer, 865 with skin cancer, 840 with cervical cancer. Logistic regression showed odds ratio (OR) of 1632.857 (95% CI 1168 - 2284, p < 0.01) for Kaposi sarcoma, 9.13 (95% CI 5.7-14.5, p-value < 0.01) for other male cancer, 8.34 (95% CI 7.68-9.06; p-value < 0.01) for Non-Hodgkin's lymphoma, 6.65 (95% CI was 5.5-8, p-value < 0.01) for Hodgkin's lymphoma, 5.04 (95% CI 4.5-5.6 p < 0.01) for rectal and anal cancer, 2.33 (95% CI 1.9-2.8, p < 0.01) for cervical cancer. Mortality was statistically significant with liver cancer, lung cancer, brain cancer, Hodgkin lymphoma, and Kaposi sarcoma. Conclusions: The prevalence of Kaposi sarcoma, Non-Hodgkin lymphoma, and cervical cancer are found to be high among hospitalized patients with HIV most likely because of nonadherence to their HIV medications. Future studies to check their correlation of these cancers with disease control is required. It is interesting to note that the prevalence of rectal and anal cancer, head and neck cancer, and skin cancer is high in this cohort.

scholarly journals Survival Improvement in Therapy Related Myeloid Neosplasm ? a Single Center Analysis of 428 Patients

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4006-4006
Author(s):  
Khalil Saleh ◽  
Christophe Willekens ◽  
Jean Edouard Martin ◽  
Myriam Kossai ◽  
Nadine Khalifé-Saleh ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Hodgkin Lymphoma ◽  
Conflicts Of Interest ◽  
Best Supportive Care ◽  
Primary Diagnosis ◽  
Study Data ◽  
Cancer Center ◽  
Complex Karyotype ◽  
Non Hodgkin Lymphoma ◽  
Radiotherapy Alone

Abstract Therapy-related acute myeloid leukemia/myelodysplastic syndrome (t-AML/MDS) arise after cytotoxic chemotherapy and/or radiotherapy administered for a prior neoplasm and have a dismal outcome (median survival of 8 months in the largest series published including 306 patients (pts), Smith, Blood 2003). Recent registry data suggested a continued increase in survival in AML (Derolf, Blood 2009) and we wondered whether this was also observed in the setting of t-AML/ MDS. All pts with a t-AML/MDS diagnosed and/or treated for their prior neoplasm at Gustave Roussy Cancer Center between July 1986 and 2016 were included in this retrospective study. Data regarding pts' demographics, primary diagnosis and treatment, latency time, cytogenetic, treatment and outcome were collected. The diagnosis of t-AML/MDS was based on the WHO 2016 classification. t-AML were classified based on cytogenetic results as favorable, intermediate and adverse according to international classification, t-MDS based on IPSS score as favorable (Low, Int-1) and adverse (Int-2 and High). 428 pts were analyzed. The median age at diagnosis of t-AML/MDS was 56.4 years with a female predominance (60%). 224/428 (52.3%) pts had t-AML, 204/428 (47.7%) t-MDS. The most common primary malignancies were breast cancer (24%), non-Hodgkin lymphoma (15%), Hodgkin lymphoma (HL) (9%) and ovarian cancer (9%). Occurrence of t-AML/MDS following HL represented 26.6% of t-AML/MDS cases between 1986-96 comparing to 4 % between 2006-16 whereas breast cancer rose from 16% to 45%. Prior treatments included chemotherapy alone in 137/428 pts (32%), radiotherapy alone in 61 pts (14%) and both in 230 pts (54%). At diagnosis of t-AML/MDS, 295 pts (69%) were in complete remission (CR) of their prior neoplasm, 29 (7%) had a stable and 104 (24%) a progressive disease. Median interval between primary cancer and t-AML/MDS was 5 years (4.3 and 5.7 years for t-AML and t-MDS respectively, (p=0.03)). Furthermore, delay to develop t-AML/MDS after radiotherapy alone was longer compare to chemotherapy or both (6.1, 5.1 and 4.3 years, respectively (p=0.0087)). In the t-AML subgroup, 47% of pts presented unfavorable cytogenetic (including complex karyotype (20%) and 11q23 abnormalities (16.9%)), 26% intermediate and 26% favorable cytogenetic (core binding factor mutations (12.7%), t(15;17) (13.3%)). In the t-MDS subgroup, 78% of pts were considered adverse; complex karyotype, chromosome 7 and 5 abnormalities were found in 40.8%, 46.7% and 28.9% respectively. Pts received intensive chemotherapy (including 41 allografts), low dose chemotherapy (including 74 treatments with hypomethylating agents) and best supportive care in 42%, 24% and 34% respectively. The median overall survival (OS) was 10.6 months and the 5-year survival was 19.1% (Figure 1A). The 5-year OS of patients in CR of their prior neoplasm was 25.5% compared to 3.65 and 0% for pts with progressive and stable disease, respectively (p<0.001). 5-year OS was not statistically different between t-AML and t-MDS subgroups (23.3% vs 13.5%) and between hematologic or oncologic malignancies as primary diagnosis (12.6% vs 21.1%). Pts with favorable risk t-AML had better 5-year survival compared with patients with intermediate or unfavorable risk disease (55.5% vs 20% vs 12.1% respectively, p<0.001). In addition, favorable t-MDS was associated with better 5-year OS compared to adverse t-MDS (34.9% vs 6.6%, p<0.001). We next compared OS of pts diagnosed for their t-AML/MDS after or before July 2001. A trend for better OS for pts diagnosed in the last 15 years was observed (21.5% vs 15.1%, p=0.39). Interestingly outcome of t-AML patients with favorable subtype significantly improved over the last 15 years (68.8% vs 25%, p=0.03, Figure 1B) which was not the case for other cytogenetic subgroups and for t-MDS, especially pts with adverse prognosis (4.6% vs 3.9%, p=0.92). Pts who received allograft had a trend for better OS in the last 15 years (52.8% vs 21.5% p=0.2). t-AML/MDS are still associated with a low 5-year OS (19.1%) but our results are upper than previous publications. However, a significant improvement of survival in favorable t-AML was observed during the past 30-years, with a trend for pts who benefit from allograft. In addition to improve treatment for t-MDS pts, detection of the disease at the earliest stage is a real challenge to improve their survival. Disclosures No relevant conflicts of interest to declare.

High incidence of Kaposi sarcoma–associated herpesvirus–related non-Hodgkin lymphoma in patients with HIV infection and multicentric Castleman disease

Blood ◽  
2002 ◽  
Vol 99 (7) ◽  
pp. 2331-2336 ◽  
Author(s):  
Eric Oksenhendler ◽  
Emmanuelle Boulanger ◽  
Lionel Galicier ◽  
Ming-Qing Du ◽  
Nicolas Dupin ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hiv Infection ◽  
Hodgkin Lymphoma ◽  
Primary Effusion Lymphoma ◽  
Human Herpesvirus ◽  
Kaposi Sarcoma ◽  
Castleman Disease ◽  
Herpesvirus Type ◽  
Multicentric Castleman Disease ◽  
Non Hodgkin Lymphoma

Multicentric Castleman disease (MCD) is a distinct type of lymphoproliferative disorder associated with inflammatory symptoms and interleukin 6 (IL-6) dysregulation. In the context of human immunodeficiency virus (HIV) infection, MCD is associated with Kaposi sarcoma–associated herpesvirus, also called human herpesvirus type 8 (KSHV/HHV8). Within a prospective cohort study on 60 HIV-infected patients with MCD, and a median follow-up period of 20 months, 14 patients developed KSHV/HHV8-associated non-Hodgkin lymphoma (NHL): 3 “classic” KSHV/HHV8+ Epstein-Barr virus–positive (EBV+) primary effusion lymphoma (PEL), 5 KSHV/HHV8+ EBV− visceral large cell NHL with a PEL-like phenotype, and 6 plasmablastic lymphoma/leukemia (3/3 KSHV/HHV8+ EBV−). The NHL incidence observed in this cohort study (101/1000 patient-years) is about 15-fold what is expected in the general HIV+ population. MCD-associated KSHV/HHV8+ NHL fell into 2 groups, suggesting different pathogenesis. The plasmablastic NHL likely represents the expansion of plasmablastic microlymphoma from the MCD lesion and progression toward aggressive NHL. In contrast, the PEL and PEL-like NHL may implicate a different original infected cell whose growth is promoted by the cytokine-rich environment of the MCD lesions.

scholarly journals 326. Is Antiretroviral Treatment Averting AIDS and non-AIDS Defining Malignancies in Colombia?

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S172-S173
Author(s):  
Ernesto Martínez Buitrago ◽  
Leonardo Arévalo Mora ◽  
Mónica Mantilla Suárez ◽  
Sandra Valderrama ◽  
Claudia Gonzáles ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Antiretroviral Treatment ◽  
Treatment Success ◽  
Kaposi Sarcoma ◽  
Retrospective Chart Review ◽  
Late Presentation ◽  
Bivariate Analysis ◽  
People Living With Hiv ◽  
Hiv Diagnosis ◽  
Cd4 Cell Count

Abstract Background The use of effective antiretroviral therapy (ART) has shown to modify the trend of AIDS-defining malignancies (ADM) toward non-AIDS defining malignancies (NADM); however, Latin America is a region with a known late presentation of HIV/AIDS and late initiation of ART, which could not result in averting the incidence of ADM. The epidemiology of cancers that define or not AIDS in people living with HIV in Colombia is not known. Methods The purpose of our study was to identify the trend of ADM and NADM and the effect of ART in a collective cohort of 15 centers of 8 cities in Colombia. After the institutional review board approval, the study was conducted as a retrospective chart review of patients with any diagnosis of cancer presented after the diagnosis of HIV and a year before. Demographic and clinical data related to the HIV infection, ART treatment, and cancer diagnosis were analyzed with Stata 12 software, and associations between different variables were made using univariate and bivariate analyses. Results A total of 415 patients with malignancies were included since 1986 (table). Most common cancers were Kaposi sarcoma (n = 227; 54.7%), and non-Hodgkin lymphoma (n = 80, 19,3%). Median CD4+ cell count was very low in this population (median 115.5, P25-75 39.5–243) at the time of HIV diagnosis. Most common NADM were skin cancer (n = 22; 5.3%) and Hodgkin lymphoma (15; 3.6%). The ratio of ADM:NADM was 0.5 before 1995 and increased progressively up to 3.0 after 2010 (P = 0.001) (figure). By bivariate analysis, we found a correlation of ADM with older age (P < 0.001), male gender (P = 0.03), recent years (P < 0.001), lower CD4 and higher VL at the time of cancer (P < 0.0001 for both), and mortality (P = 0.027). Cancer-associated mortality was 3.9%. Conclusion The trend for diagnosis of ADM in Colombia is increasing despite antiretroviral treatment and exceeds NADM diagnosis. Potential explaining factors are the late presentation and initiation of ART, and poor treatment success in this population. Special efforts are required to diagnose and treat HIV patients in Colombia to avert this worrying trend. Disclosures All authors: No reported disclosures.

Abstract 5501: The non-Hodgkin lymphoma epidemic in the United States: Recent trends in the absence of HIV-related cases

2012 ◽  
Author(s):  
Meredith S. Shiels ◽  
Eric A. Engels ◽  
Christina Clarke ◽  
H. Irene Hall ◽  
Patricia Hartge ◽  
...  
Keyword(s):  
United States ◽  
Hodgkin Lymphoma ◽  
The United States ◽  
Non Hodgkin Lymphoma ◽  
Recent Trends

Health Disparities and the Global Landscape of Lymphoma Care Today

2017 ◽  
pp. 526-534
Author(s):  
Adrienne A. Phillips ◽  
Dominic A. Smith
Keyword(s):  
Health Disparities ◽  
Hodgkin Lymphoma ◽  
Standard Treatment ◽  
Treatment Approach ◽  
B Cell Lymphoma ◽  
The United States ◽  
Non Hodgkin Lymphoma ◽  
Large B Cell Lymphoma ◽  
Distinct Disease ◽  
Disease Entities

Lymphoma encompass a wide variety of distinct disease entities, including, but not limited to, subtypes of non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL). In the last 3 decades, therapeutic advancements have resulted in substantial improvements in lymphoma outcome. In most high-income regions, HL is a largely curable disease and for patients with two frequent subtypes of NHL, diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL), survival has dramatically improved with the incorporation of rituximab as a standard treatment approach. Despite these advances, outcomes vary between and across populations. This review will provide updated information about health disparities in lymphoma in the United States and across the globe.

Clinical Outcome of Therapy-Related Acute Myeloid Leukemia Is Strongly Related to Cytogenetic Analysis

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1401-1401
Author(s):  
Croix Fossum ◽  
Rhett P. Ketterling ◽  
Lindsey E. Roeker ◽  
Ajoy L. Dias ◽  
Michelle Elliott ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Hodgkin Lymphoma ◽  
Alkylating Agent ◽  
De Novo ◽  
Disease Course ◽  
Primary Malignancy ◽  
Non Hodgkin Lymphoma ◽  
Cytogenetic Profile ◽  
De Novo Aml

Abstract Background: Treatment-related AML (t-AML) accounts for 10 to 20% of all AML cases and carries an especially poor prognosis (Kayser et al. 2011, Godley et al. 2008). Patients diagnosed with t-AML are likely to have abnormal cytogenetic profiles with chromosome changes that are predictive of an aggressive malignancy, poor response to therapy, and decreased overall survival(Smith et al. 2003). The simultaneous use of multiple chemotherapeutic agents of different classes makes it increasingly difficult to predict risk for developing t-AML and determining disease course. An updated analysis of predictive factors for t-AML is needed so clinicians can more accurately inform patients of their prognosis. The aim of this study was to classify t-AML according to primary malignancy, previous chemotherapy exposure, and cytogenetic profile. Methods: A retrospective chart review of patients that were diagnosed with AML at Mayo Clinic from 7/1/1990 to 5/13/2015 was performed following IRB approval. AML patients found to have a previous malignancy treated with chemotherapy were classified as t-AML. Chemotherapeutics were classified as alkylating agents, antimetabolites, anti-tubulin agents, and topoisomerase II inhibitors. Patients diagnosed with a myelodysplastic or myeloproliferative disorder prior to development of AML were excluded from this study. Previous chemotherapy exposures, duration of chemotherapy exposure, complete blood count, chromosome abnormalities, and survival data were collected for t-AML cases. Cytogenetic changes were classified as favorable, intermediate, and adverse according to the system used by Kayser et al. 2011. JMP 10.0 was used for statistical analysis. Results: Out of 584 patients, 64 patients (11%) had a primary malignancy that was treated with chemotherapy prior to being diagnosed with AML. The most common primary malignancies were breast cancer (31%), non-Hodgkin lymphoma (27%), colorectal cancer (8%), and Hodgkin lymphoma (8%). Laboratory findings showed median hemoglobin 9.6 g/dL (4.7-13.8), median white blood cells 3.2 x109 (0.6-126), median platelets 50x109 (3-320), median peripheral blood blasts of 8% (0-91), and median bone marrow blasts 38% (1-94). 95% of patients diagnosed with t-AML had been previously treated with an alkylating agent. Additional exposure to an anti-metabolite trended towards a more adverse cytogenetic profile (χ2=5.0, p=0.08) but there was not a statistically significant decrease in overall survival (KM analysis, p=0.31). The median overall survival for patients diagnosed with t-AML was 10.2 months compared to 19.2 months for patients with de-novo AML (KM analysis, p=0.04). Adverse cytogenetic profiles were associated with decreased survival (KM analysis, p <0.0001). However, there was no difference in overall survival between patients with t-AML that had intermediate cytogenetics and those with de-novo AML (KM analysis, p=0.36). None of the chemotherapy classes other than antimetabolites were associated with poor cytogenetics or survival when combined with an alkylating agent. Conclusion: Over half of all patients classified as having t-AML in this study received prior chemotherapy for breast cancer or non-Hodgkin lymphoma. Cytogenetic classification of t-AML into favorable, intermediate and adverse groups is useful in predicting disease course. Interestingly, t-AML patients with intermediate risk cytogenetics had similar overall survival to patients with de-novo AML. This suggests that the poor outcomes observed in patients with t-AML is predominantly due to the subset with adverse cytogenetics. Thus, cytogenetic analysis remains the best indicator of overall survival regardless of chemotherapy exposure. Additional work is needed to delineate the risk associated with the aforementioned chemotherapy classes. Disclosures Al-Kali: Celgene: Research Funding.

Factors influencing treatment of inflammatory breast cancer in the United States.

2015 ◽  
Vol 33 (28_suppl) ◽  
pp. 118-118
Author(s):  
Heather Y. Lin ◽  
Gildy Babiera ◽  
Isabelle Bedrosian ◽  
Simona Flora Shaitelman ◽  
Henry Mark Kuerer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Inflammatory Breast Cancer ◽  
Standard Of Care ◽  
High Volume ◽  
The United States ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Cancer Data ◽  
Number Of Patients ◽  
Facility Level

118 Background: Guidelines for treating inflammatory breast cancer (IBC) using trimodality (chemotherapy, surgery and radiation) therapy (TT) remain largely unchanged since 2000. However, many such patients did not receive TT. It is unknown how patient-level (PL) and facility-level (FL) factors contribute to TT utilization. Methods: Using the National Cancer Data Base (NCDB), patients who underwent surgical treatment of locoregional IBC from 2003-2011 were identified. We correlated patient, tumor, and treatment data with TT. An observed to expected (O/E) ratio of number of patients treated with TT was calculated for each hospital by adjusting for PL factors. Hierarchical mixed effects models were used to assess the proportion of variation in the use of TT attributable to PL and FL factors, respectively. Results: Among 5,537 patients who met the study criteria, the use of TT fluctuated annually (67.3%-75.7%) and was less likely for patients who were over 70, had a lower income or had an N0 tumor (all p < 0.05). By insurance type, TT use was lowest among Medicare patients. Of the 542 hospitals examined, 55 (10.1%) and 24 (4.4%) were identified as significantly low and high outliers for the use of TT (p < 0.05), respectively. While comprehensive cancer centers represented the majority of high outliers, the TT use by facility type overall was not significantly different demonstrating variability within comprehensive cancer center practice. The percentage of the total variance in the use of TT attributable to facility (11%) was almost triple the variance attributable to the measured PL factors (3.4%). Conclusions: The use of standard of care TT varied widely across facilities with some high volume centers clearly underutilizing TT. To improve clinical outcomes for this rare and aggressive malignancy, it is critical to identify facility level factors impacting the use of TT to ensure the guideline adherence of IBC treatment.

Incidence and characterization of pure non-urothelial bladder and upper tract cancers: A 10-year review.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 414-414
Author(s):  
Kanika Gupta ◽  
Ehab El Bahesh ◽  
Antoine Nafez Finianos ◽  
Brandon Clark ◽  
Samuel Simmens ◽  
...  
Keyword(s):  
Overall Survival ◽  
Bladder Cancer ◽  
Urothelial Carcinoma ◽  
Randomized Clinical Trials ◽  
Retrospective Chart Review ◽  
The United States ◽  
Primary Treatment ◽  
Treatment Modalities ◽  
Cancer Center ◽  
Favorable Histology

414 Background: Bladder cancer is the sixth most common malignancy in the United States. Urothelial carcinoma makes up 90% of bladder cancer histology, which may be pure or mixed. It includes adenocarcinoma (Ad), squamous (SqC), glandular, sarcomatoid (St), micropapillary, small cell (SC) and plasmacytoid variants. Pure non-urothelial cancers have worse overall survival compared to urothelial cancer with mixed histologic features. However, little research has been done to characterize pure non-urothelial histologies, and there are no randomized clinical trials evaluating treatment modalities for non-urothelial cancers. This retrospective study characterizes pure non-urothelial cancers and their treatments. Methods: A retrospective chart review of the last 10 years was performed using data from the George Washington University Cancer Center Tumor Registry Data. Statistical analysis was done using the Fisher’s test and Kaplan-Meier survival curves. Results: Out of 449 consecutive patients with bladder cancers, 19 patients had pure non-urothelial carcinoma (4.2%): 7 SqC, 6 Ad, 3 SC, 2 lymphoma (Ly), and 1 St. SqC and Ad were more likely than SC to be diagnosed at an advanced stage (p = 0.04), with median age of diagnosis at 53.5 years for Ad, 68 years for SC and 69 years for Sq. None of the SC metastasized. Primary treatment for 94% of patients was a surgical intervention (9 TURBT, 2 partial cystectomy, 2 radical cystectomy, and 2 nephroureterectomy); 1 received neoadjuvant therapy. 11 patients received adjuvant chemotherapy – 7 with gemcitabine-based regimens and 10 with platinum-based regimens. While not statistically significant, median overall survival varied – 404 days for Ad, 213 days for SqC, and 1567 days for SC. Conclusions: SC was a more favorable histology when compared to SqC or Ad, presenting at an earlier stage with lower incidence of metastasis that perhaps reflected the improved overall survival. Identifying patients with more aggressive disease earlier allows for the potential role for more aggressive therapies that may result in improved outcomes. While the sample size is small, it identifies characteristics and potential differences between bladder cancer with rare histologies.

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