MP10-19 SYSTEMIC THERAPY AND OVERALL SURVIVAL TRENDS IN PATIENTS WITH NON-UROTHELIAL HISTOLOGIC VARIANTS OF MUSCLE INVASIVE BLADDER CANCER UNDERGOING RADICAL CYSTECTOMY

Abstract

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation II1 Apr 2017MP10-19 SYSTEMIC THERAPY AND OVERALL SURVIVAL TRENDS IN PATIENTS WITH NON-UROTHELIAL HISTOLOGIC VARIANTS OF MUSCLE INVASIVE BLADDER CANCER UNDERGOING RADICAL CYSTECTOMY Shreyas Joshi, Elizabeth Handorf, Andres Correa, Benjamin ristau, Michael Haifler, Robert Uzzo, Richard Greenberg, David Chen, Rosalia Viterbo, Alexander Kutikov, Daniel Geynisman, and Marc Smaldone Shreyas JoshiShreyas Joshi More articles by this author , Elizabeth HandorfElizabeth Handorf More articles by this author , Andres CorreaAndres Correa More articles by this author , Benjamin ristauBenjamin ristau More articles by this author , Michael HaiflerMichael Haifler More articles by this author , Robert UzzoRobert Uzzo More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , David ChenDavid Chen More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Daniel GeynismanDaniel Geynisman More articles by this author , and Marc SmaldoneMarc Smaldone More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.347AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Histological variants of Urothelial carcinoma (UC) of the bladder have a poorer prognosis than histologically pure TCC, and the role of neoadjuvant chemotherapy (NAC) is unclear. Our objective was to evaluate NAC practice patterns and survival outcomes in patients with histologic variants undergoing radical cystectomy (RC) using a large national tumor registry. METHODS Patients with cT2-4N0-3Mx muscle invasive bladder cancer (MIBC) who underwent RC from 2003-2014 were selected from the National Cancer Database (NCDB). Patients were categorized by histology code as pure UC or histologic variants. Adjusting for patient and clinical characteristics, generalized estimating equations were used to test the association between histology and receipt of NAC. The association between receipt of NAC and overall survival (OS) was evaluated using Kaplan Meier curves and Cox regression models. RESULTS In 23,723 patients meeting inclusion criteria, receipt of NAC in histologic variants was less (12-15%) than in pure UC (28%), with the exception of micropapillary disease (29%) [Table 1]. Median OS was lower in variant histologies than for pure UC (11.1 - 29.2 vs. 39.0 months). Receipt of NAC was associated with improved survival compared to RC or RC+adjuvant chemotherapy in patients with pure UC (HR 0.88, p < 0.0001). There was no evidence of a survival benefit for NAC in the variant histologies, or that treatment effects differed by histology (P-val for interaction=0.87). CONCLUSIONS In the NCDB, a substantial proportion of patients (15%) with histologic variants of MIBC undergoing RC receive NAC in the absence of a proven survival benefit. Clinical trials inclusive of patients with variant histologies are necessary to elucidate the role of NAC prior to RC. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e115-e116 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Shreyas Joshi More articles by this author Elizabeth Handorf More articles by this author Andres Correa More articles by this author Benjamin ristau More articles by this author Michael Haifler More articles by this author Robert Uzzo More articles by this author Richard Greenberg More articles by this author David Chen More articles by this author Rosalia Viterbo More articles by this author Alexander Kutikov More articles by this author Daniel Geynisman More articles by this author Marc Smaldone More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...