PD51-03 IMPACT OF NEOADJUVANT CHEMOTHERAPY ON PATHOLOGIC DOWNSTAGING IN PATIENTS WITH VARIANT HISTOLOGY UNDERGOING RADICAL CYSTECTOMY

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive III (PD51)1 Sep 2021PD51-03 IMPACT OF NEOADJUVANT CHEMOTHERAPY ON PATHOLOGIC DOWNSTAGING IN PATIENTS WITH VARIANT HISTOLOGY UNDERGOING RADICAL CYSTECTOMY Rebecca Campbell, Abhinav Khanna, Stephen Boorjian, Jacob Knorr, Roni Cox, Marlo Nicholas, Vidit Sharma, Prithvi Murthy, Robert Tarrell, Prabin Thapa, Matthew Tollefson, R. Houston Thompson, Igor Frank, R. Jeffrey Karnes, Georges-Pascal Haber, and Byron Lee Rebecca CampbellRebecca Campbell More articles by this author , Abhinav KhannaAbhinav Khanna More articles by this author , Stephen BoorjianStephen Boorjian More articles by this author , Jacob KnorrJacob Knorr More articles by this author , Roni CoxRoni Cox More articles by this author , Marlo NicholasMarlo Nicholas More articles by this author , Vidit SharmaVidit Sharma More articles by this author , Prithvi MurthyPrithvi Murthy More articles by this author , Robert TarrellRobert Tarrell More articles by this author , Prabin ThapaPrabin Thapa More articles by this author , Matthew TollefsonMatthew Tollefson More articles by this author , R. Houston ThompsonR. Houston Thompson More articles by this author , Igor FrankIgor Frank More articles by this author , R. Jeffrey KarnesR. Jeffrey Karnes More articles by this author , Georges-Pascal HaberGeorges-Pascal Haber More articles by this author , and Byron LeeByron Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002078.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Variant histology (VH) bladder cancer is often associated with poor outcomes and the role of neoadjuvant chemotherapy (NAC) prior to radical cystectomy (RC) in this population is poorly defined. The objective of this study was to determine if NAC results in similar pathologic downstaging at RC for patients with and without VH. METHODS: We retrospectively reviewed RC registries from two large tertiary referral centers and identified patients with pure or mixed VH (sarcomatoid, small cell carcinoma, nested, micropapillary and plasmacytoid) who underwent RC (1980-2018). Patients with VH were matched 1:2 with pure urothelial carcinoma patients by age, sex, pT-stage, pN-stage, and the receipt of NAC. The primary outcome was pathologic downstaging, defined as pT stage lower than cT stage. The differential impact of NAC on pathologic downstaging between VH and non-VH was assessed using a multivariable logistic regression with an interaction analysis. RESULTS: 889 patients were identified with median (IQR) follow-up of 4.39 (2.21-8.63) years, including 303 VH and 586 non-VH patients. Rates of clinical and pathologic ³T2 were: 239/303 (78.9%) and 286/303 (94.3%) in the VH cohort and 466/586 (79.5%) and 553/586 (94.3%) in the non-VH cohort, respectively. Overall, 68/889 (7.6%) patients experienced downstaging, including 28/153 (18.3%) patients who received NAC. The rates of downstaging after NAC for individual histologic subgroups were: 19 (19.0%) urothelial, 3 (33.3%) sarcomatoid, 0 (0%) small cell carcinoma, 2 (15.4%) nested, 3 (21.4%) micropapillary, and 1 (16.7%) plasmacytoid. The rates of downstaging in patients who did not receive NAC were: 22 (4.5%) urothelial, 4 (8.3%) sarcomatoid, 2 (3.5%) small cell carcinoma, 3 (7.5%) nested, 7 (9.3%) micropapillary, and 2 (6.7%) plasmacytoid. On multivariable analyses, NAC was associated with increased likelihood of downstaging in the overall cohort (OR 3.99, 95% CI 2.36-6.74, p<0.001) and this effect was not modified by VH vs non-VH histology (p=0.26 for interaction). CONCLUSIONS: The likelihood of downstaging following NAC for patients with VH is similar to that of matched urothelial controls, suggesting that NAC may have utility for VH patients. Future studies in larger cohorts of the individual variant histologies are warranted. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e906-e906 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rebecca Campbell More articles by this author Abhinav Khanna More articles by this author Stephen Boorjian More articles by this author Jacob Knorr More articles by this author Roni Cox More articles by this author Marlo Nicholas More articles by this author Vidit Sharma More articles by this author Prithvi Murthy More articles by this author Robert Tarrell More articles by this author Prabin Thapa More articles by this author Matthew Tollefson More articles by this author R. Houston Thompson More articles by this author Igor Frank More articles by this author R. Jeffrey Karnes More articles by this author Georges-Pascal Haber More articles by this author Byron Lee More articles by this author Expand All Advertisement Loading ...