MP55-18 SARCOMATOID UROTHELIAL CARCINOMA: CLINICO-PATHOLOGICAL ANALYSIS OF 93 CASES WITH EMPHASIS ON PT1 OUTCOMES IN PATIENTS WHO UNDERWENT EARLY CYSTECTOMY AND/OR NEOADJUVANT CHEMOTHERAPY

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive II (MP55)1 Apr 2020MP55-18 SARCOMATOID UROTHELIAL CARCINOMA: CLINICO-PATHOLOGICAL ANALYSIS OF 93 CASES WITH EMPHASIS ON PT1 OUTCOMES IN PATIENTS WHO UNDERWENT EARLY CYSTECTOMY AND/OR NEOADJUVANT CHEMOTHERAPY Vamsi Parimi (Parini)*, Kara Lombardo, Woonyoung Choi, Trinity Bivalacqua, Max Kates, Noah Hahn, David McConkey, and Andres Matoso Vamsi Parimi (Parini)*Vamsi Parimi (Parini)* More articles by this author , Kara LombardoKara Lombardo More articles by this author , Woonyoung ChoiWoonyoung Choi More articles by this author , Trinity BivalacquaTrinity Bivalacqua More articles by this author , Max KatesMax Kates More articles by this author , Noah HahnNoah Hahn More articles by this author , David McConkeyDavid McConkey More articles by this author , and Andres MatosoAndres Matoso More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000924.018AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Sarcomatoid urothelial carcinoma (SUC) is an unusual variant that bears poor prognosis. Guidelines recommend consideration for early radical cystectomy (RC) in patients with SUC and pT1 tumors. We studied clinicopathologic parameters associated with prognosis for patients receiving neoadjuvant chemotherapy (NAC) Cisplatin+Gemcytobine regimen. METHODS: A retrospective review identified 93 patients who were diagnosed as SUC between 1993 and 2018. H&Es from biopsies/TURB and post NAC RC specimens were reviewed by expert GU pathologists (VP/AM) and tumor size, size of sarcoma component and % of sarcoma were annotated. Log-Rank test, T-test and Spearman correlation were used to assess outcomes. RESULTS: Median age was 70 yrs; male:female ratio was 3.5:1. Of 93, 27% were 100% sarcomatoid, and 73% were mixed with conventional UC. The mean sizes of total tumor and SUC component were 6cm (SD ± 3.7cm) and 4.5cm (SD ± 3.7cm) respectively. Neither the size of tumor nor percent of the sarcomatoid component correlate with survival (p>0.05). The distribution of SUC by pT stage (pretreatment) was 6%, 31%, 41% and 17% (T1, T2, T3 and T4); 5% were unknown. The average overall survival (OS) was 30 months (range 1-198 months). The OS at 5 years was 10%. The mean OS without RC (n=12) was shorter (8.3 months; p<0.05). The mean SUC tumor size at RC among patients receiving no NAC (n=47) vs NAC (n=20) was 4.6 and 2.8 cm respectively (T-test, p>0.05). There was a significant global difference in OS among patients with different pT stages (pT1-pT4) (Log-Rank Test. P=0.003). There were 6 patients with pT1 tumors with an average age of 68 years and were all males. Four patients had SUC associated with papillary UC, one with flat carcinoma in-situ and one with squamous cell carcinoma. Two pT1 patients received NAC and both had no residual tumor at RC. Four of six patients were alive at an average follow-up of 49 months (1 with metastatic disease, 3 with no evidence of disease), 1 died of disease (patient with small cell carcinoma) and 1 was lost to follow-up. CONCLUSIONS: Our data suggest that the mean OS without RC was significantly shorter compared to patients who underwent RC. Despite the small number of patients with pT1 tumors, they seem to have better survival after cystectomy suggesting that early radical surgery in these patients could be beneficial, and NAC also correlated with better OS. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e845-e845 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vamsi Parimi (Parini)* More articles by this author Kara Lombardo More articles by this author Woonyoung Choi More articles by this author Trinity Bivalacqua More articles by this author Max Kates More articles by this author Noah Hahn More articles by this author David McConkey More articles by this author Andres Matoso More articles by this author Expand All Advertisement PDF downloadLoading ...