390 THE IMPACT OF MIXED HISTOLOGAL FEATURES ON SURVIVAL FOLLOWING RADICAL CYSTECTOMY FOR UROTHELIAL CARCINOMA

Abstract

You have accessJournal of UrologyUrothelial Cancer: Natural History & Pathophysiology/Marker1 Apr 2012390 THE IMPACT OF MIXED HISTOLOGAL FEATURES ON SURVIVAL FOLLOWING RADICAL CYSTECTOMY FOR UROTHELIAL CARCINOMA Simon Kim, Igor Frank, John Cheville, R. Houston Thompson, Christopher Weight, Prabin Thapa, and Stephen Boorjian Simon KimSimon Kim Rochester, MN More articles by this author , Igor FrankIgor Frank Rochester, MN More articles by this author , John ChevilleJohn Cheville Rochester, MN More articles by this author , R. Houston ThompsonR. Houston Thompson Rochester, MN More articles by this author , Christopher WeightChristopher Weight Rochester, MN More articles by this author , Prabin ThapaPrabin Thapa Rochester, MN More articles by this author , and Stephen BoorjianStephen Boorjian Rochester, MN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.454AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The presence of mixed histological features (MH) in patients with urothelial carcinoma (UC) of the bladder has been associated with locally-advanced disease at radical cystectomy (RC), and has been suggested to predict response to neoadjuvant chemotherapy. The impact of MH on survival, however, remains to be defined. We investigated comparative clinical and pathologic outcomes of patients undergoing RC for pure UC versus those with UC and MH. METHODS We identified 1,150 patients who underwent RC at Mayo Clinic between 1980-2007, including 827 (72%) with pure UC and 323 (28%) with UC and MH. MH patients included those with squamous differentiation (n=132), glandular differentiation (n=41), or both (n=13); micropapillary features (n=67); nested variant of UC (n=49); and UC with sarcomatoid histology (n=21). All specimens were re-reviewed by a single genitourinary pathologist. Cancer specific survival (CSS) was estimated using the Kaplan-Meier method and compared with the log-rank test. The association of MH with death from UC was evaluated using multivariable Cox proportional hazard regression analysis. RESULTS Median follow-up after RC was 8.4 years (interquartile range 3.0, 13.5). In total, 502 patients died of bladder cancer, including 147 with MH and 355 with pure UC. No significant difference between the cohorts was noted with regard to patient age (p=0.78), gender (p=0.26), ECOG (p=0.29), or surgical margin status (p=0.41). Patients with UC and MH were more likely to have pT3-T4 tumors (69.3% vs 38.7%; p<0.0001) and pN+ disease (26.3% vs 15.4%; p<0.0001) compared to patients with pure UC. Interestingly, however, postoperative 10-year CSS did not significantly differ between patients with UC and MH and patients with pure UC (47% vs 51%; p=0.18). Moreover, after adjusting for clinicopathologic features (Table). the presence of MH was associated a decreased risk of death from UC (HR 0.82; p=0.05). Multivariate Analysis of Clinicopathologic Variables Associated with Death from UC after RC Variable HR 95% CI p Value Age at RC 1.01 0.99,1.01 0.34 ECOG PS 1.34 1.08,1.65 0.007 pT2 (vs pTa/Tis/T1) 1.61 1.20,2.15 0.002 pT3 (vs pTa/Tis/T1) 3.22 2.45,4.23 <0.0001 pN+ 1.44 1.16,1.78 0.001 Positive surgical margin 1.60 1.15,2.22 0.005 UC with MH (vs pure UC) 0.82 0.67,1.00 0.05 CONCLUSIONS Patients with UC and MH at RC were more likely to have extravesical tumors and node-positive disease. Nevertheless, these patients did not have adverse CSS compared to patients with pure UC. In fact, the presence of MH was associated with a nearly 20% lower risk of death from UC. Additional studies are needed to further define prognostic factors for the individual sub-types of UC that encompass MH. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e160 Peer Review Report Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Simon Kim Rochester, MN More articles by this author Igor Frank Rochester, MN More articles by this author John Cheville Rochester, MN More articles by this author R. Houston Thompson Rochester, MN More articles by this author Christopher Weight Rochester, MN More articles by this author Prabin Thapa Rochester, MN More articles by this author Stephen Boorjian Rochester, MN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...