MP49-17 CLINICAL OUTCOMES OF PATIENTS WITH HISTOLOGIC VARIANTS OF BLADDER CANCER TREATED WITH TRIMODAL BLADDER-SPARING THERAPY

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive III1 Apr 2016MP49-17 CLINICAL OUTCOMES OF PATIENTS WITH HISTOLOGIC VARIANTS OF BLADDER CANCER TREATED WITH TRIMODAL BLADDER-SPARING THERAPY Ross Krasnow, Hannah Roberts, Michael Drumm, Andrzej Niemierko, Chin-Lee Wu, Adam Feldman, Matthew Wszolek, Richard Lee, Michael Blute, Anthony Zietman, William Shipley, and Jason Efstathiou Ross KrasnowRoss Krasnow More articles by this author , Hannah RobertsHannah Roberts More articles by this author , Michael DrummMichael Drumm More articles by this author , Andrzej NiemierkoAndrzej Niemierko More articles by this author , Chin-Lee WuChin-Lee Wu More articles by this author , Adam FeldmanAdam Feldman More articles by this author , Matthew WszolekMatthew Wszolek More articles by this author , Richard LeeRichard Lee More articles by this author , Michael BluteMichael Blute More articles by this author , Anthony ZietmanAnthony Zietman More articles by this author , William ShipleyWilliam Shipley More articles by this author , and Jason EfstathiouJason Efstathiou More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.430AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The clinical outcomes of patients with histologic variants of muscle invasive bladder cancer (MIBC) treated with radical cystectomy is an emerging topic. While trimodal bladder-sparing therapy (TMT) is an acceptable treatment for selected patients with MIBC, the outcomes of TMT in histologic variants remains largely unknown. To our knowledge, we present the largest series of urothelial histologic variants treated with TMT. METHODS In this retrospective cohort study of 195 patients treated with TMT from 2001 until 2013, the outcomes of patients with pure urothelial carcinoma (PUC) and variant urothelial carcinoma (VUC) were compared with Kaplan Meier survival probabilities, and univariate and multivariate Cox regression analysis, controlling for age, stage, the completeness of TURBT resection, and response to induction therapy. All patients had in-house pathology review by dedicated genitourinary pathologists. RESULTS Of the 195 patients who were treated with TMT, 38 (19.5%) had VUC. Of those, 29 (76.3%) had VUC with squamous and/or glandular differentiation and 9 (23.7%) were other forms of VUC. Median follow-up for surviving patients was 5.4 years. The complete response (CR) rate after induction TMT was 91.4% in PUC and 87.5% in VUC (p=0.77). The 5-year overall survival (OS) was 64% [95% CI 55-72%] in PUC and 63% [95% CI 43-78%] in VUC (log rank P=0.80), and the 5-year disease specific survival (DSS) was 74% [95% CI 66%-81%] in PUC and 74% [95% CI 51-87%] in VUC (log rank P=0.78). VUC was not associated with OS on univariate (HR 1.1 [95% CI 0.6-1.9]) or multivariate (HR 1.2 [95% CI 0.7-2.3]) Cox regression analysis. Similarly, there was no association with DSS (HR 1.0 [95% CI 0.4-2.3]). Finally, there was no difference in the crude rate of immediate or delayed salvage cystectomy between the two groups (PUC 26 (15.9%), VUC 6 (15.8%), p=0.9). CONCLUSIONS The VUC subtypes in this study responded to TMT, and there was no difference in CR, OS, DSS, or salvage cystectomy rates compared to PUC. These findings are consistent with RC literature, which suggest that the response of certain VUC subtypes is driven by stage and grade. The presence of VUC should not exclude patients from TMT. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e670 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Ross Krasnow More articles by this author Hannah Roberts More articles by this author Michael Drumm More articles by this author Andrzej Niemierko More articles by this author Chin-Lee Wu More articles by this author Adam Feldman More articles by this author Matthew Wszolek More articles by this author Richard Lee More articles by this author Michael Blute More articles by this author Anthony Zietman More articles by this author William Shipley More articles by this author Jason Efstathiou More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...