Effect of variant histology presence and squamous differentiation on oncological results and patient’s survival after radical cystectomy

Objective: To evaluate the effect of variant histology on pathological and survival findings in patients undergoing radical cystectomy due to muscle invasive bladder cancer. Materials and methods: Data from 146 patients with radical cystectomy performed due to muscle-invasive urothelial carcinoma between January 2006 to November 2016 at our clinic were investigated. The preoperative and postoperative data of patients with variant histology were compared with nonvariant urothelial carcinoma patients. Then of patients with variant histology only those with squamous differentiation (SqD) were compared with nonvariant urothelial carcinoma patients in terms of preoperative, postoperative and survival data. Results: Of the 146 patients, 23 had carcinoma with variant histology. Of these, 17 had SqD, 4 had glandular differentiation, 1 patient had plasmocytoid variant and 1 patient had sarcomatoid variant. In patients with variant histology, postoperative T stage and upstaging was higher, with no difference observed in terms of overall and cancer-specific survival compared with nonvariant urothelial cancer patients. SqD patients were observed to have higher postoperative T stage compared to nonvariant urothelial cancer patients, with no significant difference observed in terms of survival. Conclusions: In cystectomy pathologies, patients with variant histology (especially SqD patients) were observed to have proportionally higher T stage compared to nonvariant urothelial carcinoma; however there were no significant differences for overall survival and cancer-specific survival.

Download Full-text

Comparative effectiveness of radical cystectomy versus bladder-sparing treatment for muscle-invasive urothelial carcinoma: A population-based report.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.4_suppl.334 ◽

2014 ◽

Vol 32 (4_suppl) ◽

pp. 334-334 ◽

Cited By ~ 1

Author(s):

Maxine Sun ◽

Giorgio Gandaglia ◽

Pierre I. Karakiewicz ◽

Jim C. Hu ◽

Simon P. Kim ◽

...

Keyword(s):

Urothelial Carcinoma ◽

Radical Cystectomy ◽

Advanced Disease ◽

Population Based ◽

Disease Stage ◽

Treatment Modalities ◽

Radiation Hazard ◽

Survival Outcomes ◽

Significant Difference ◽

Muscle Invasive

334 Background: Radical cystectomy (RC) represents the standard of care for patients with muscle-invasive urothelial carcinoma of the urinary bladder (UCUB). Alternative organ-conserving treatments such as chemotherapy and/or radiotherapy have gained interest. We sought to compare survival outcomes of patients according to treatment modalities, in a stage-for-stage analysis. Methods: We relied on the Surveillance, Epidemiology, and End Results Medicare-linked database to identify 12,950 patients diagnosed with T2–T4a N0/x M0 UCUB between years 1992 and 2009. Treatment types include RC (n=5207), chemotherapy/radiation (n=2,669), and surveillance (n=5,074). Following instrumental variable analysis, Cox- and competing-risks regression analyses were performed for prediction of overall survival (OS) and cancer-specific mortality (CSM), respectively. All analyses were stratified according to disease stage (T2, T3, T4a). Results: After adjusting for potential confounders, OS was more favorable for RC relative to chemotherapy/radiation (hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 1.02–2.40) or surveillance (HR: 1.82, 95% CI: 1.20–2.78) in patients with T2 UCUB. For the same stage, CSM rates were lower in the surgery group compared to chemotherapy/radiation (HR: 2.05, 95% CI: 1.14–3.67) or surveillance (HR: 1.95, 95% CI: 1.09–3.48). When analyses focused on individuals with more advanced disease (T3–T4a), no statistically significant difference was observed between chemotherapy/radiation relative to RC for both OS and CSM. Conclusions: In the current retrospective population-based cohort, RC was associated with improved survival outcomes relative to its alternative treatment counterparts. However, this effect was only observable in patients with T2 disease. Conversely, no difference between chemotherapy/radiation vs. surgery was noted in patients with more advanced disease stage.

Download Full-text

Clinical outcome and quality of life in octogenarian patients with muscle-invasive urothelial carcinoma of the bladder treated with radical cystectomy or transurethral resection of the bladder tumor: a retrospective analysis of 143 patients

International Urology and Nephrology ◽

10.1007/s11255-021-03073-5 ◽

2021 ◽

Author(s):

Christian Rehme ◽

Beatrix Fritsch ◽

Luca Thomas ◽

Stefan Istin ◽

Carolin Burchert ◽

...

Keyword(s):

Quality Of Life ◽

Clinical Outcome ◽

Urothelial Carcinoma ◽

Radical Cystectomy ◽

Transurethral Resection ◽

Cox Regression ◽

Wilcoxon Test ◽

Cancer Specific Survival ◽

Muscle Invasive

Abstract Purpose To compare clinical outcome and quality of life (QoL) in octogenarian patients with muscle-invasive urothelial carcinoma (MIBC) either treated by radical cystectomy (RC) or transurethral resection of the tumor (TURBT). Methods We identified octogenarian patients with MIBC in our institutions since 2005. Clinical treatment outcomes and QoL were analyzed. Uni- and multivariable Cox regression analyses, two-tailed Wilcoxon test, Mann–Whitney test and Fisher’s exact test were assessed as appropriate. QoL was evaluated using FACT-G (Functional Assessment of Cancer Therapy-General) questionnaire. Results 143 patients were identified (RC: 51 cases, TURBT: 92 cases). Mean follow-up was 14 months (0–100 months). Median overall survival (OS) was 12 months in the RC group and 7 months in the TURBT group. TURBT and low preoperative hemoglobin were independent risk factors for reduced cancer-specific survival (CSS) (TURBT: p = 0.019, Hb: p = 0.008) and OS (TURBT: p = 0.026, Hb: p = 0.013) in multivariable analyses. Baseline QoL was low throughout the whole cohort. There was no difference in baseline FACT-G scoring comparing RC and TURBT (FACT-G total score (median): RC 43.7/108 vs. TURBT 44.0/108, p = 0.7144). Increased FACT-G questionnaire scoring was assessed for RC patients (median percentage score change RC 22.9%, TURBT 2.3%, p < 0.0001). Conclusion RC and TURBT are feasible treatment options for MIBC in octogenarian patients. In our cohort, RC was associated with increased CSS, OS and QoL. QoL in general was low throughout the whole cohort. Interdisciplinary decision-making has to be improved for these critically ill patients.

Download Full-text

MP58-16 ONCOLOGIC OUTCOMES OF SQUAMOUS CELL CARCINOMA VERSUS UROTHELIAL CARCINOMA WITH SQUAMOUS DIFFERENTIATION AFTER RADICAL CYSTECTOMY FOR MUSCLE INVASIVE BLADDER CANCER (MIBC)

The Journal of Urology ◽

10.1016/j.juro.2017.02.1811 ◽

2017 ◽

Vol 197 (4S) ◽

Author(s):

Mahmoud Laymon ◽

Ahmed Mansour ◽

Mohamed M. Elsaadany ◽

Ahmed Mosbah ◽

Shaaban AA ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Bladder Cancer ◽

Urothelial Carcinoma ◽

Cell Carcinoma ◽

Radical Cystectomy ◽

Squamous Cell ◽

Oncologic Outcomes ◽

Squamous Differentiation ◽

Muscle Invasive Bladder Cancer ◽

Muscle Invasive

Download Full-text

Can we reliably identify patients for radical cystectomy without neoadjuvant chemotherapy?

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.7_suppl.258 ◽

2011 ◽

Vol 29 (7_suppl) ◽

pp. 258-258 ◽

Cited By ~ 1

Author(s):

R. J. Dickstein ◽

H. B. Grossman ◽

S. M. Pretzsch ◽

J. A. Karam ◽

R. E. Millikan ◽

...

Keyword(s):

High Risk ◽

Neoadjuvant Chemotherapy ◽

Radical Cystectomy ◽

Lymphovascular Invasion ◽

Urothelial Cancer ◽

Recurrent Disease ◽

Disease Recurrence ◽

Salvage Chemotherapy ◽

Variant Histology ◽

Muscle Invasive

258 Background: When neoadjuvant chemotherapy is administered prior to radical cystectomy in patients with muscle-invasive urothelial cancer, the patients who benefit most are those with pathologic T3-4 or N+ disease. Thus, some advocate reserving neoadjuvant chemotherapy for patients considered high risk based on presence of the following clinical parameters: lymphovascular invasion, hydroureteronephrosis, presence of a palpable or visible mass on exam under anesthesia or imaging (suggesting cT3 disease), and/or variant histology. The goal of this study was to report the outcome of patients who were classified as “not high risk” (i.e., lacking the above-mentioned criteria) and underwent radical cystectomy without neoadjuvant chemotherapy. Methods: On retrospective review of 858 patients who underwent radical cystectomy from 2000 to 2008, we identified 174 patients with muscle-invasive disease (cT2) who were classified as “not high risk” (i.e., did not have lymphovascular invasion, hydroureteronephrosis, variant histology, and/or palpable or visible mass on imaging studies) and underwent radical cystectomy without neoadjuvant chemotherapy. Endpoints of interest included pathologic upstaging (≥ pT3), pathologic lymph node positivity, need for adjuvant or salvage chemotherapy, disease recurrence, and disease specific survival (DSS). Results: Of the 174 patients, 155 (88.6%) were male and the median age was 67.6 years (range 39-86). At radical cystectomy, 75 patients (42.9%) were upstaged (pT3N0: 45; pT4N0: 6; pTxN+: 24). Thirteen patients (7.4%) received adjuvant chemotherapy for adverse pathology. After a median interval of 27 months, 38 patients (21.7%) developed recurrent disease; isolated pelvic recurrences: 4, distant recurrences: 34, and 2 had both. Eighteen patients with recurrent disease went on to receive salvage chemotherapy. Overall, 25 patients (14.3%) died of disease with a 5-year DSS of 82.3%. Conclusions: Although clinical understaging remains a problem in the management of patients with muscle-invasive urothelial cancer, our criteria for selection of patients for primary radical cystectomy without neoadjuvant chemotherapy results in a cohort with a 5-year DSS of 83%. No significant financial relationships to disclose.

Download Full-text