1768 IMPACT OF MICROPAPILLARY UROTHELIAL CARCINOMA VARIANT HISTOLOGY ON SURVIVAL AFTER RADICAL CYSTECTOMY: A MULTI-INSTITUTIONAL ANALYSIS

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You have accessJournal of UrologyBladder Cancer: Invasive (III)1 Apr 20131768 IMPACT OF MICROPAPILLARY UROTHELIAL CARCINOMA VARIANT HISTOLOGY ON SURVIVAL AFTER RADICAL CYSTECTOMY: A MULTI-INSTITUTIONAL ANALYSIS Adrian Fairey, Eila Skinner, Stephen Boorjian, Jeffrey Wang, Igor Frank, Mark Schoenberg, Eric Hyndman, Adam Reese, Gary Steinberg, Michael Large, Christina Hulsbergen-vandeKaa, Max Bruins, Jie Cai, and Siamak Daneshmand Adrian FaireyAdrian Fairey Los Angeles, CA More articles by this author , Eila SkinnerEila Skinner Stanford, CA More articles by this author , Stephen BoorjianStephen Boorjian Rochester, MN More articles by this author , Jeffrey WangJeffrey Wang Rochester, MN More articles by this author , Igor FrankIgor Frank Rochester, MN More articles by this author , Mark SchoenbergMark Schoenberg Baltimore, MD More articles by this author , Eric HyndmanEric Hyndman Baltimore, MD More articles by this author , Adam ReeseAdam Reese Baltimore, MD More articles by this author , Gary SteinbergGary Steinberg Chicago, IL More articles by this author , Michael LargeMichael Large Chicago, IL More articles by this author , Christina Hulsbergen-vandeKaaChristina Hulsbergen-vandeKaa Radboud, Netherlands More articles by this author , Max BruinsMax Bruins Radboud, Netherlands More articles by this author , Jie CaiJie Cai Los Angeles, CA More articles by this author , and Siamak DaneshmandSiamak Daneshmand Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2897AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The role of micropapillary urothelial carcinoma (MUC) variant histology as an independent prognostic factor for survival after radical cystectomy (RC) is controversial. We report the first multi-institutional analysis to examine the impact of MUC on survival outcomes. METHODS Institutional bladder cancer databases containing detailed information on patients treated with RC between 1980 and 2011 were obtained from 5 academic centers. Data were collected on 1,497 patients and combined into a relational database formatted with patient characteristics, pathologic characteristics, and survival status. All surgical specimens underwent institutional pathologic review by genitourinary pathologists. Histologic type was categorized as urothelial carcinoma (UC; N=1,346) or MUC (N=151). Patients were classified as MUC if they had any component of MUC in the pathologic specimen. The Kaplan-Meier method and Cox proportional regression models were used to analyze overall survival (OS) and recurrence-free survival (RFS). RESULTS Median follow-up was 10.0 years for the UC group and 7.8 years for the MUC group (P=0.01). Median age (67 years vs 67 years, P=0.81), sex (male: 80% vs 83%, P=0.39), neoadjuvant chemotherapy use (7% vs 5%, P=0.37), adjuvant chemotherapy use (21% vs 27%, P=0.10), and clinical TNM stage (≤cT2N0M0: 91% vs 89%; ≥cT3N0M0: 7% vs 7%; cTanyN1-3M0: 2% vs 4%, P=0.35) did not differ between the UC and MUC groups. Notably, MUC was associated with advanced pathologic TNM stage (≤pT2N0M0: 27% vs 60%; ≥pT3N0M0: 23% vs 18%; pTanyN1-3M0: 50% vs 22%, P<0.01) and a higher rate of lymphovascular invasion (LVI) (58% vs 29%, P<0.01). Moreover, compared to patients with UC, patients with MUC were noted on unadjusted analysis to have poorer OS (5-year: 38% vs 61%, P<0.01) and RFS (5-year: 44% vs 70%, P<0.01). However, in multivariable analysis controlling for age, sex, pathologic TNM stage, LVI, and perioperative chemotherapy use, histologic type was not independently associated with OS (HR 1.19, 95% CI 0.96-1.49, P=0.12) or RFS (HR 1.16, 95% CI 0.89-1.53, P=0.27). CONCLUSIONS This multi-institutional analysis showed that, while MUC was associated with locally advanced disease at RC, survival outcomes are similar to those for UC when controlling for clinicopathologic tumor features. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e727 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Adrian Fairey Los Angeles, CA More articles by this author Eila Skinner Stanford, CA More articles by this author Stephen Boorjian Rochester, MN More articles by this author Jeffrey Wang Rochester, MN More articles by this author Igor Frank Rochester, MN More articles by this author Mark Schoenberg Baltimore, MD More articles by this author Eric Hyndman Baltimore, MD More articles by this author Adam Reese Baltimore, MD More articles by this author Gary Steinberg Chicago, IL More articles by this author Michael Large Chicago, IL More articles by this author Christina Hulsbergen-vandeKaa Radboud, Netherlands More articles by this author Max Bruins Radboud, Netherlands More articles by this author Jie Cai Los Angeles, CA More articles by this author Siamak Daneshmand Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...