Contemporary treatment and survival differences in patients with urothelial versus nonurothelial bladder and upper tract carcinomas: Analyses from the National Cancer Database (NCDB).

Abstract

463 Background: Non-urothelial bladder and upper tract cancers are known to have worse prognosis than urothelial cancers. Further descriptive analyses of patterns of demographic presentation, stage, metastases and response to chemotherapy and immunotherapy are explored through the NCDB database. Methods: The primary objective of this retrospective review is to evaluate trends and differences between upper tract urothelial cancers (UTUC) versus non-urothelial (nUTUC) histologies (squamous, sarcomatoid, small cell or neuroendocrine, adenocarcinoma) and bladder urothelial cancer (UC) and bladder non-urothelial cancer (nUC) and compare the demographics, disease characteristics, treatment, incidence of stage and survival according to NCDB. Results: Data from diagnosis in year 2004 – 2017 were extracted from the NCDB. A total of 649939 cases of whom 630423 were urothelial and 19516 were non-urothelial for both bladder and upper tract cancers were identified. More men were diagnosed with urothelial carcinoma, UTUC (62%) and bladder UC (75%). The median age was similar for both groups, 71.4 years (UC) and 70.1 years (nUC). Majority were Caucasian at 91.6% (UC) and 85.7% (nUC) while African-American patients consisted of 5.26% in the UC and 10.8% in the nUC cohorts. Primary surgery occurred more frequently in the UC cohort (94.7%) compared to the nUC (87%). More patients were diagnosed with stage IV cancer in the nUC group (21.9%) compared to UC at 4.6%, and overall survival was slightly worse with nUC for stage IV cancers with median OS of 7.92 mos (CI, (7.75, 8.08) for UC vs 6.14 mos (CI, (5.78, 6.47) nUC; logrank p = < 0.001, although the biggest numeric difference was in the stage 0 and stage I patients with mOS of 110.13 mos (CI, 109.44, 110.82) versus 46.09 mos (CI, 42.09, 50.66), p < 0.001. Use of chemotherapy resulted in improved overall survival in the UC group with mOS of 73.53 mos (CI, 72.61, 74.41) compared to nUC at 17.28 mos (CI, (16.59, 17.87), p < 0.0001 and use of immunotherapy similarly yielded improvement in the UC group with mOS of 115.98 mos (CI, 114.33- 117.65) compared to nUC at 64.49 mos (CI, 45.67, 88.51); p < 0.0001. Conclusions: Urothelial cancer of both bladder and upper tract origin compared to non-urothelial cancers tend to have better prognosis in both presentation at diagnosis and with early stage cancers as well as treatment in advanced stages with chemotherapy or immunotherapy, highlighting the need for better therapeutic strategies for non-urothelial cancers.