MP34-11 NEOADJUVANT CHEMOTHERAPY PRIOR TO RADICAL CYSTECTOMY FOR MUSCLE-INVASIVE BLADDER CANCER WITH VARIANT HISTOLOGY

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive II1 Apr 2017MP34-11 NEOADJUVANT CHEMOTHERAPY PRIOR TO RADICAL CYSTECTOMY FOR MUSCLE-INVASIVE BLADDER CANCER WITH VARIANT HISTOLOGY Malte W. Vetterlein, Stephanie Mullane, Thomas Seisen, Richard Lander, Björn Löppenberg, Toni K. Choueiri, Joaquim Bellmunt, Mani Menon, Adam S. Kibel, Quoc-Dien Trinh, and Mark A. Preston Malte W. VetterleinMalte W. Vetterlein More articles by this author , Stephanie MullaneStephanie Mullane More articles by this author , Thomas SeisenThomas Seisen More articles by this author , Richard LanderRichard Lander More articles by this author , Björn LöppenbergBjörn Löppenberg More articles by this author , Toni K. ChoueiriToni K. Choueiri More articles by this author , Joaquim BellmuntJoaquim Bellmunt More articles by this author , Mani MenonMani Menon More articles by this author , Adam S. KibelAdam S. Kibel More articles by this author , Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author , and Mark A. PrestonMark A. Preston More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1028AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Neoadjuvant chemotherapy in pure urothelial bladder cancer provides a significant survival benefit. However, it is unknown if this benefit persists in histological variants of bladder cancer. We aimed to assess the effect of neoadjuvant chemotherapy on overall survival (OS) and upstaging at radical cystectomy in the five most common histological variants. METHODS Querying the National Cancer Data Base, we identified 1,555 patients with histological variants undergoing radical cystectomy for muscle-invasive bladder cancer between 2003-2011. Neoadjuvant chemotherapy was defined as multiagent systemic therapy administered within 180 days prior to surgery. Histological variants were categorized as pure neuroendocrine tumors, squamous cell carcinoma, and adenocarcinoma, or micropapillary and sarcomatoid differentiation. Cox regression models were used to examine the effect of neoadjuvant chemotherapy on overall mortality in each variant subgroup. Logistic regression models estimated the odds of pathological upstaging at radical cystectomy for each histological variant, stratified by the receipt of neoadjuvant chemotherapy. RESULTS In multivariate analyses, an OS benefit for neoadjuvant chemotherapy was only found in neuroendocrine tumors (hazard ratio [HR]=0.64; 95% confidence interval [CI]=0.45-0.90; P=0.012). Neuroendocrine tumors (odds ratio [OR]=0.38; 95% CI=0.22-0.67; P=0.001), along with micropapillary (OR=0.16; 95% CI=0.05-0.47; P=0.001) and sarcomatoid differentiated tumors (OR=0.34; 95% CI=0.14-0.87; P=0.025), were less likely to be upstaged at radical cystectomy when treated with neoadjuvant chemotherapy. In squamous cell and adenocarcinoma, no favorable pathological outcomes were seen in patients receiving neoadjuvant chemotherapy vs. radical cystectomy alone (all P>0.08). Specifically, patients with squamous cell carcinoma even trended towards worse pathology (i.e. upstaging) at RC if they received neoadjuvant chemotherapy (OR=1.81; 95% CI=[0.93-3.52]; P=0.081) compared to patients undergoing RC alone. CONCLUSIONS Patients with neuroendocrine tumors benefit from neoadjuvant chemotherapy, as evidenced by better OS and lower rates of pathological upstaging at radical cystectomy. In micropapillary and sarcomatoid differentiated tumors, neoadjuvant chemotherapy decreased pathological upstaging at cystectomy. However, this favorable effect did not translate into a statistically significant OS benefit for these patients, potentially due to the aggressive tumor biology. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e431 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Malte W. Vetterlein More articles by this author Stephanie Mullane More articles by this author Thomas Seisen More articles by this author Richard Lander More articles by this author Björn Löppenberg More articles by this author Toni K. Choueiri More articles by this author Joaquim Bellmunt More articles by this author Mani Menon More articles by this author Adam S. Kibel More articles by this author Quoc-Dien Trinh More articles by this author Mark A. Preston More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...