Micropapillary Bladder Cancer Research Articles

Nomograms for predicting survival in patients with micropapillary bladder cancer: a real-world analysis based on the surveillance, epidemiology, and end results database and external validation in a tertiary center

BackgroundThe present study aimed to construct and validate nomograms that can be used to predict cancer-specific survival (CSS) and overall survival (OS) in patients with micropapillary bladder cancer.MethodsThe data of 627 patients diagnosed with micropapillary bladder cancer between 2000 and 2018 were obtained from the surveillance, epidemiology, and end results database. Patients were randomly divided into the training and internal validation sets (7:3). The Cox proportional hazards regression model was applied to evaluate the association between variables and survival and then nomograms were constructed to predict the survival of an individual patient. The performance of nomograms was validated by using calibration curves, concordance index, receiver operating characteristic curves with the calculated area under the curve and decision curve analysis in the training and internal validation set. Data from 41 micropapillary bladder cancer patients at Qilu Hospital of Shandong University from 2000 to 2022 were collected for external validation.ResultsSeveral independent risk factors were taken into the two nomograms (CSS and OS), including age, marital status, AJCC TMN stage, surgical approach, lymph node ratio, and tumor size while the OS nomogram additionally contained race. The concordance index of the training set, internal validation set, and external verification set were all over 0.7. The calibration curve indicated good consistence between the nomogram prediction and actual survival. Area under the curve and decision curve analysis results indicated great clinical usefulness of nomograms.ConclusionsThe nomograms predicting the survival outcome of patients with micropapillary bladder cancer would provide a valuable tool to help clinicians to evaluate the risk of patients and make individual treatment strategies.

Micropapillary bladder cancer: an evolving biology.

To summarize a comprehensive overview of more recent evidence on micropapillary bladder cancer (MPBC), focusing on actual incidence, clinical features, therapeutic strategies, and prognosis. MPBC generally exhibits an aggressive behaviour compared with pure urothelial carcinoma (pUC) with advances in tumour stage and nodal and distant spread at diagnosis. Due to its rarity and presence of only small sample size and retrospective studies, no consensus currently exists regarding the most effective therapeutic strategy to be performed among nonmuscle-invasive (conservative treatment versus immediate radical cystectomy) and muscle-invasive MPBC (neoadjuvant therapy versus upfront radical cystectomy versus adjuvant chemotherapy). The incidence of MPBC is recently increased according to latter literature, ranging from 2.9 to 7.6% of all bladder cancer. Despite its aggressive behaviour at time of presentation, more recent evidence fails to demonstrate a significant association between MPBC and worse outcomes compared with pUC when adjusted for clinical and pathological features. According to latter evidence, MPBC pathological response to NAC appears to be unsatisfactory compared with pUC patients while neoadjuvant immunotherapy with Pembrolizumab may represent an effective treatment among MPBC patients, based on PD-L1 and TMB expression.

Variant histologies in bladder cancer: Does the centre have an impact in detection accuracy?

To compare the accuracy in detecting variant histologies (VH) at transurethral resection of bladder (TURB) and radical cystectomy (RC) specimen among tertiary referral centres, in order to investigate potential reasons of discrepancies from the pathological point of view. Clinical and histopathological data of TURB specimen and subsequent cystectomy specimen of 3,445 RC candidate patients have been retrospectively collected from 24 tertiary referral centres between 1980 and 2021. VH considered in the analysis were pure squamous cell carcinoma, urothelial carcinoma with squamous differentiation, pure adenocarcinoma, urothelial carcinoma with glandular differentiation, micropapillary bladder cancer (BCa), neuroendocrine BCa, and other variants. The degree of agreement between TURB and RC concerning the identification of VH was expressed as concordance, classified according to Cohen's kappa coefficient. A VH was reported in 17% of TURB specimens, 45% of which were not confirmed in RC. The lowest concordance rate was reported for micropapillary BCa with 11 out of 18 (61%) centres reporting no agreement, whereas neuroendocrine BCa achieved the highest concordance rate with only 3 centres (17%) reporting no agreement. Our results shows that even among centres with the advantage of a referent uropathologist the micropapillary variant is characterized by scarce accuracy between TURB and RC. Differences in TURB specimen acquisition by the urologist and in sampling methods among different centres are the main limitations of the study. Accuracy of TURB in detecting VH is poor for certain VH, in particular for micropapillary BCa, with evident variation among centres. Novel diagnostic tools are required to better identify these VH and drive patients toward a personalized treatment.

MP06-02 NON-MUSCLE-INVASIVE MICROPAPILLARY BLADDER CANCER HAS A DISTINCT LNCRNA PROFILE ASSOCIATED WITH UNFAVORABLE PROGNOSIS

You have accessJournal of UrologyCME1 May 2022MP06-02 NON-MUSCLE-INVASIVE MICROPAPILLARY BLADDER CANCER HAS A DISTINCT LNCRNA PROFILE ASSOCIATED WITH UNFAVORABLE PROGNOSIS Joep de Jong, Begoña Valderrama, Julia Perera, Nuria Juanpere, Paloma Cejas, Henry Long, Mar Alba, Ewan Gibb, and Joaquim Bellmunt Joep de JongJoep de Jong More articles by this author , Begoña ValderramaBegoña Valderrama More articles by this author , Julia PereraJulia Perera More articles by this author , Nuria JuanpereNuria Juanpere More articles by this author , Paloma CejasPaloma Cejas More articles by this author , Henry LongHenry Long More articles by this author , Mar AlbaMar Alba More articles by this author , Ewan GibbEwan Gibb More articles by this author , and Joaquim BellmuntJoaquim Bellmunt More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002523.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Molecular subtyping of bladder cancer has revealed luminal tumors generally have a more favorable prognosis. However, some aggressive forms of variant histology, including micropapillary, are often classified luminal. In previous work, we found long non-coding RNA (lncRNA) expression profiles could identify a subgroup of luminal bladder tumors with less aggressive biology and better outcomes. In the present study, we aimed to investigate whether lncRNA expression profiles could identify high-grade T1 micropapillary bladder cancer with differential outcome. METHODS: LncRNAs were quantified from RNA-seq data from a HG T1 bladder cancer cohort that was enriched for primary micropapillary cases (15/84). Unsupervised consensus clustering of variant lncRNAs identified a three-cluster solution, which was characterized using a panel of micropapillary-associated biomarkers, molecular subtypes, gene signatures and survival analysis. A single-sample genomic signature was trained using lasso-penalized logistic regression to classify micropapillary-like gene-expression, as characterized by lncRNA clustering. The genomic classifier (GC) was tested on luminal tumors derived from the TCGA cohort (N=202). Primary endpoints were overall, progression-free and high-grade recurrence-free survival. RESULTS: Primary micropapillary HGT1 showed decreased FGFR3, SHH and p53 pathway activity relative to tumors with conventional urothelial carcinoma. Many bladder cancer-associated lncRNAs were downregulated in micropapillary tumors, including UCA1, LINC00152, and MALAT1. Unsupervised consensus clustering resulted in a lncRNA cluster (LC1) with worse prognosis that was enriched for primary micropapillary histology and the Luminal Unstable (LumU) molecular subtype. Interestingly, LC1 appeared to better identify aggressive HG T1 disease, compared to stratifying outcomes using primary histologic characteristics. A signature trained to identify LC1 cases showed good performance in the testing cohort, identifying seven cases with significantly worse survival (p<0.001). CONCLUSIONS: Using the lncRNA transcriptome we identified a subgroup of aggressive HGT1 bladder cancer that was enriched with micropapillary histology. These data suggest that lncRNAs can facilitate the identification of aggressive micropapillary-like tumors, potentially improving patient management. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e77 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joep de Jong More articles by this author Begoña Valderrama More articles by this author Julia Perera More articles by this author Nuria Juanpere More articles by this author Paloma Cejas More articles by this author Henry Long More articles by this author Mar Alba More articles by this author Ewan Gibb More articles by this author Joaquim Bellmunt More articles by this author Expand All Advertisement PDF DownloadLoading ...

Non-muscle-invasive micropapillary bladder cancer has a distinct lncRNA profile associated with unfavorable prognosis.

Molecular subtyping of bladder cancer has revealed luminal tumors generally have a more favourable prognosis. However, some aggressive forms of variant histology, including micropapillary, are often classified luminal. In previous work, we found long non-coding RNA (lncRNA) expression profiles could identify a subgroup of luminal bladder tumors with less aggressive biology and better outcomes. In the present study, we aimed to investigate whether lncRNA expression profiles could identify high-grade T1 micropapillary bladder cancer with differential outcome. LncRNAs were quantified from RNA-seq data from a HGT1 bladder cancer cohort that was enriched for primary micropapillary cases (15/84). Unsupervised consensus clustering of variant lncRNAs identified a three-cluster solution, which was further characterised using a panel of micropapillary-associated biomarkers, molecular subtypes, gene signatures, and survival analysis. A single-sample genomic signature was trained using lasso-penalized logistic regression to classify micropapillary-like gene-expression, as characterised by lncRNA clustering. The genomic classifier (GC) was tested on luminal tumors derived from the TCGA cohort (N = 202). Patient and tumor characteristics were compared between subgroups by using X2 tests and two-sided Wilcoxon rank-sum tests. Primary endpoints were overall, progression-free and high-grade recurrence-free survival, calculated as the date of high-grade T1 disease at TURBT till date of death from any cause, progression, or recurrence, respectively. Survival rates were estimated using weighted Kaplan-Meier (KM) curves. Primary micropapillary HGT1 showed decreased FGFR3, SHH, and p53 pathway activity relative to tumors with conventional urothelial carcinoma. Many bladder cancer-associated lncRNAs were downregulated in micropapillary tumors, including UCA1, LINC00152, and MALAT1. Unsupervised consensus clustering resulted in a lncRNA cluster 1 (LC1) with worse prognosis that was enriched for primary micropapillary histology and the Luminal Unstable (LumU) molecular subtype. Interestingly, LC1 appeared to better identify aggressive HGT1 disease, compared to stratifying outcomes using primary histologic characteristics. A signature trained to identify LC1 cases showed good performance in the testing cohort, identifying seven cases with significantly worse survival (p < 0.001). Limitations include the retrospective nature of the study and the lack of a validation cohort. Using the lncRNA transcriptome we identified a subgroup of aggressive HGT1 bladder cancer that was enriched with micropapillary histology. These data suggest that lncRNAs can facilitate the identification of aggressive micropapillary-like tumors, potentially improving patient management.

A0083 - Non-muscle-invasive micropapillary bladder cancer has a distinct lncRNA profile associated with unfavorable prognosis

A0083 - Non-muscle-invasive micropapillary bladder cancer has a distinct lncRNA profile associated with unfavorable prognosis

Non-muscle invasive micropapillary urothelial carcinoma of the bladder: Variable use of initial cystectomy versus intravesical bacillus calmette-guérin

Introduction and Objective Micropapillary urothelial carcinoma (MPUC) is a rare and aggressive histologic variant of bladder cancer. Treatment guidelines recommend forgoing Bacillus Calmette-Guérin (BCG) therapy in favor of early radical cystectomy for non-muscle invasive (NMI)-MPUC due to high rates of disease progression. We aimed to evaluate its management in patients with immediate cystectomy and BCG across various centers. Methods Patients with MPUC were identified from the National Cancer Database (2004-2017). Treatment trends and rates of pathological upstaging were identified. Bivariate and multivariate analyses were performed to assess differences in outcomes by treatment approach. Results 1,685 patients were diagnosed with MPUC during the study period with 531 identified with localized Ta, T1, or Tis disease. BCG was administered as an initial therapy in 24.1% of NMI-MPBC patients and in 16.3% of NMI-non-MPUC patients (p&lt;0.001). Cystectomy was performed as primary therapy for NMI disease in 29.9% of MPUC and in 2.7% of non-MPUC patients (p&lt;0.001). Of the patients who underwent primary cystectomy, upstaging from NMI-MPUC to T2-T4 disease was seen in 46.5% of the MPUC patients compared to 37.3% in patients with non-MPUC (p=0.025). Upstaging to pathologic N1-3 disease was observed in 33.1% of MPUC patients compared to 11.9% non-MPUC patients (p&lt;0.001). Cox regression analysis, adjusting for patient age, sex, race, comorbidities, and disease stage, care at academic cancer centers were associated with increased odds of having cystectomy as primary therapy compared to community cancer centers (OR = 4.29, 95% CI 2.73-6.76). Conclusion The current study lends evidence to current practice guidelines by reporting treatment patterns for patients with micropapillary bladder cancer across a broad spectrum of clinical practice. NMI-MPUC patients treated at academic cancer centers were more likely to receive radical surgery as primary treatment compared to patients at the community cancer centers.

Non-muscle invasive micropapillary urothelial carcinoma of the bladder: Variable use of initial cystectomy versus intravesical bacillus calmette-guérin

Introduction and Objective Micropapillary urothelial carcinoma (MPUC) is a rare and aggressive histologic variant of bladder cancer. Treatment guidelines recommend forgoing Bacillus Calmette-Guérin (BCG) therapy in favor of early radical cystectomy for non-muscle invasive (NMI)-MPUC due to high rates of disease progression. We aimed to evaluate its management in patients with immediate cystectomy and BCG across various centers. Methods Patients with MPUC were identified from the National Cancer Database (2004-2017). Treatment trends and rates of pathological upstaging were identified. Bivariate and multivariate analyses were performed to assess differences in outcomes by treatment approach. Results 1,685 patients were diagnosed with MPUC during the study period with 531 identified with localized Ta, T1, or Tis disease. BCG was administered as an initial therapy in 24.1% of NMI-MPBC patients and in 16.3% of NMI-non-MPUC patients (p&lt;0.001). Cystectomy was performed as primary therapy for NMI disease in 29.9% of MPUC and in 2.7% of non-MPUC patients (p&lt;0.001). Of the patients who underwent primary cystectomy, upstaging from NMI-MPUC to T2-T4 disease was seen in 46.5% of the MPUC patients compared to 37.3% in patients with non-MPUC (p=0.025). Upstaging to pathologic N1-3 disease was observed in 33.1% of MPUC patients compared to 11.9% non-MPUC patients (p&lt;0.001). Cox regression analysis, adjusting for patient age, sex, race, comorbidities, and disease stage, care at academic cancer centers were associated with increased odds of having cystectomy as primary therapy compared to community cancer centers (OR = 4.29, 95% CI 2.73-6.76). Conclusion The current study lends evidence to current practice guidelines by reporting treatment patterns for patients with micropapillary bladder cancer across a broad spectrum of clinical practice. NMI-MPUC patients treated at academic cancer centers were more likely to receive radical surgery as primary treatment compared to patients at the community cancer centers.

SC11 - Survival outcomes after radical cystectomy versus conservative management for T1 high grade non-muscle invasive micropapillary bladder cancer: a multicentre collaboration by the European Association of Urology – young academic urologists (EAU-YAU): urothelial carcinoma working group

SC11 - Survival outcomes after radical cystectomy versus conservative management for T1 high grade non-muscle invasive micropapillary bladder cancer: a multicentre collaboration by the European Association of Urology – young academic urologists (EAU-YAU): urothelial carcinoma working group

PD63-11 ONCOLOGICAL OUTCOMES OF CT1 MICROPAPILLARY BLADDER CANCER COMPARED WITH CT2 CONVENTIONAL UROTHELIAL CARCINOMA TREATED WITH RADICAL CYSTECTOMY

You have accessJournal of UrologyBladder Cancer: Non-invasive III (PD63)1 Sep 2021PD63-11 ONCOLOGICAL OUTCOMES OF CT1 MICROPAPILLARY BLADDER CANCER COMPARED WITH CT2 CONVENTIONAL UROTHELIAL CARCINOMA TREATED WITH RADICAL CYSTECTOMY Kevin Ginsburg, Akhil Chandra, Nicole Murray, Elizabeth Handorf, Laura Bukavina, David Chen, Richard Greenberg, Rosalia Viterbo, Robert Uzzo, Alexander Kutikov, Marc Smaldone, and Andres Correa Kevin GinsburgKevin Ginsburg More articles by this author , Akhil ChandraAkhil Chandra More articles by this author , Nicole MurrayNicole Murray More articles by this author , Elizabeth HandorfElizabeth Handorf More articles by this author , Laura BukavinaLaura Bukavina More articles by this author , David ChenDavid Chen More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , Robert UzzoRobert Uzzo More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , and Andres CorreaAndres Correa More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002107.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The management of patients with high risk non-muscle invasive urothelial carcinoma (UC) is complex due to the biological heterogeneity of the disease. The management of micropapillary (MP) bladder cancer, which commonly present at advanced stages, pose a significant treatment dilemma when diagnosed in the non-muscle invasive setting. We investigated the oncological outcomes of cT1 MP bladder cancer compared with cT2 conventional UC in patients treated with early radical cystectomy. METHODS: We reviewed the National Cancer Database for patients undergoing RC for cT1 MP and conventional cT1/cT2 UC from 2004 to 2016. We fit multivariable models to test for an association between histology and clinical T stage with OS, pathologically node positive disease (pN+), and upgrading to pT3/4 disease at RC. Models were adjusted for the use of systemic therapy, radiation therapy, comorbidity score, age, year of diagnosis, race, urban/rurality index, education status, income, sex, transfer status, distance from treating facility, and facility type. cT2 UC served as the reference category. RESULTS: We identified 27,453 patients that met inclusions, of which 125 had cT1 MP, 7,017 cT1 UC, and 20,311 cT2 UC disease. Compared with patients with cT2 UC, patients with cT1 MP had similar OS (HR 0.74, 95% CI 0.54-1.01, p=0.059) while patients cT1 UC (HR 0.70, 95% CI 0.66-0.74, p<0.001) had improved OS. More patients with cT1 MP had pN+ disease (39%) compared with patients with cT1 and cT2 UC (11% and 19%, respectively). After adjustment in the multivariable model, compared with patients with cT2 UC, patients with cT1 MP had increased odds of pN+ disease (OR 1.74, 95% CI 1.15-2.64, p=0.009) while patients with cT1 TC had decreased odds of pN+ disease (OR 0.76, 95% CI 0.70-0.83, p<0.001). More patients with cT1 MP were upstaged to pT3/4 at RC (31%) compared with patients with cT1 and cT2 UC (18% and 27%, respectively). After adjustment in the multivariable model, compared with patients with cT2 UC, patients with cT1 MP experienced similar odds of upstaging to pT3/4 at RC (OR 0.96, 95% CI 0.63-1.44, p=0.830) while upstaging was less common in patients with cT1 UC (OR 0.60, 95% CI 0.55-0.65, p<0.001). CONCLUSIONS: In patients treated with RC, patients with cT1 MP had similar or worse oncological outcomes compared with patients with cT2 UC, while patients with cT1 UC had consistently favorable outcomes compared with patients with cT2 UC. These comparisons may help patients and clinicians while debating treatment options in those with cT1 MP bladder cancer. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1142-e1142 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Ginsburg More articles by this author Akhil Chandra More articles by this author Nicole Murray More articles by this author Elizabeth Handorf More articles by this author Laura Bukavina More articles by this author David Chen More articles by this author Richard Greenberg More articles by this author Rosalia Viterbo More articles by this author Robert Uzzo More articles by this author Alexander Kutikov More articles by this author Marc Smaldone More articles by this author Andres Correa More articles by this author Expand All Advertisement Loading ...

MP16-18 SURVIVAL OUTCOMES AFTER RADICAL CYSTECTOMY VERSUS CONSERVATIVE MANAGEMENT FOR T1 HIGH GRADE NON-MUSCLE INVASIVE MICROPAPILLARY BLADDER CANCER: A MULTICENTER COLLABORATION BY THE EUROPEAN ASSOCIATION OF UROLOGY - YOUNG ACADEMIC UROLOGISTS

MP16-18 SURVIVAL OUTCOMES AFTER RADICAL CYSTECTOMY VERSUS CONSERVATIVE MANAGEMENT FOR T1 HIGH GRADE NON-MUSCLE INVASIVE MICROPAPILLARY BLADDER CANCER: A MULTICENTER COLLABORATION BY THE EUROPEAN ASSOCIATION OF UROLOGY - YOUNG ACADEMIC UROLOGISTS

MP16-05 UTILIZATION OF INITIAL CYSTECTOMY VERSUS INTRAVESICAL BACILLUS CALMETTE-GUÉRIN FOR NON-MUSCLE INVASIVE MICROPAPILLARY UROTHELIAL CARCINOMA OF THE BLADDER

You have accessJournal of UrologyBladder Cancer: Non-invasive II (MP16)1 Sep 2021MP16-05 UTILIZATION OF INITIAL CYSTECTOMY VERSUS INTRAVESICAL BACILLUS CALMETTE-GUÉRIN FOR NON-MUSCLE INVASIVE MICROPAPILLARY UROTHELIAL CARCINOMA OF THE BLADDER Karishma Gupta, Danly Omil-Lima, Lin Chen, Wade Muncey, Irma Lengu, and Kyle Scarberry Karishma GuptaKarishma Gupta More articles by this author , Danly Omil-LimaDanly Omil-Lima More articles by this author , Lin ChenLin Chen More articles by this author , Wade MunceyWade Muncey More articles by this author , Irma LenguIrma Lengu More articles by this author , and Kyle ScarberryKyle Scarberry More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002001.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Micropapillary urothelial carcinoma is a rare and aggressive histologic variant of bladder cancer. Treatment guidelines recommend forgoing Bacillus Calmette-Guérin (BCG) therapy in favor of early radical cystectomy for non-muscle invasive micropapillary bladder cancer (NMI-MPBC) due to high rates of disease progression. We hypothesize that management of NMI-MPBC will vary across centers. METHODS: Patients with MPBC were identified from the National Cancer Database (2004-2017). Treatment trends and rates of pathological upstaging were identified. Bivariate and multivariate analyses were performed to assess differences in outcomes by treatment approach. RESULTS: 1,685 patients were diagnosed with MPBC during the study period with 531 identified to have localized Ta, T1, or Tis disease on presentation. BCG therapy was administered as initial therapy in 24.1% of NMI-MPBC patients and in 16.3% of non-micropapillary NMI-UC patients (p<0.001). Cystectomy was performed as primary therapy for NMI disease in 29.9% of MPBC and in 2.7% of non-micropapillary patients (p<0.001). Of the patients who underwent primary cystectomy, upstaging from NMI disease to T2-T4 disease was seen in 46.5% of the MPBC patients compared to 37.3% in patients with non-micropapillary disease (p=0.025). Upstaging to pathologic N1-3 disease was observed in 33.1% of MPBC patients compared to 11.9% non-micropapillary patients (p<0.001). Cystectomy as primary therapy for NMI-MPBC was more likely to be performed at academic (45.5%) compared to community cancer centers (15.6%) (p<0.001). On Cox regression analysis, adjusting for patient age, sex, race, comorbidities, and disease stage, care at academic cancer centers was associated with increased odds of having cystectomy as primary therapy compared to community cancer centers (OR = 4.29, 95% CI 2.73-6.76). Primary BCG therapy was not utilized any more frequently between academic (20.7%) and community cancer centers (27.1%) (p=0.093). CONCLUSIONS: The micropapillary variant of urothelial carcinoma is associated with increased odds of disease upstaging and node-positive disease. BCG is overutilized as primary treatment in this population. NMI-MPBC patients treated at academic centers were more likely to receive radical surgery as primary treatment compared to patients at community cancer centers. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e297-e297 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Karishma Gupta More articles by this author Danly Omil-Lima More articles by this author Lin Chen More articles by this author Wade Muncey More articles by this author Irma Lengu More articles by this author Kyle Scarberry More articles by this author Expand All Advertisement Loading ...

Survival Outcomes After Immediate Radical Cystectomy Versus Conservative Management with Bacillus Calmette-Guérin Among T1 High-grade Micropapillary Bladder Cancer Patients: Results from a Multicentre Collaboration

BackgroundLiterature lacks clear evidence regarding the optimal treatment for non–muscle-invasive micropapillary bladder cancer (MPBC) due to its rarity and the presence of only small sample size and single-centre studies. ObjectiveTo assess cancer-specific mortality (CSM) and overall mortality (OM) between immediate radical cystectomy (RC) and conservative management among T1 high-grade (HG) MPBC. Design, setting, and participantsWe retrospectively analysed a multicentre dataset including 119 T1 HG MPBC patients treated between 2005 and 2019 at 15 tertiary referral centres. The median follow-up time was 35 mo (interquartile range: 19–64). InterventionPatients underwent immediate RC versus conservative management with bacillus Calmette-Guérin. Outcomes measurements and statistical analysisCumulative incidence functions and Kaplan-Meier methods were applied to estimate survival outcomes. Multivariable Cox analyses were performed to assess independent predictors of disease recurrence and disease progression after conservative management; covariates consisted of pure MPBC, concomitant lymphovascular invasion (LVI), and carcinoma in situ at initial diagnosis. Results and limitationsImmediate RC and conservative management were performed in 27% and 73% of patients, respectively. CSM and OM did not differ significantly among patient treated with immediate RC versus conservative management (Pepe-Mori test p = 0.5 and log-rank test p = 0.9, respectively). Overall, 66.7% and 34.5% of patients experienced disease recurrence and disease progression after conservative management, respectively. At multivariable Cox analyses, concomitant LVI was an independent predictor of disease recurrence (p = 0.01) and progression (p = 0.03), while pure MPBC was independently associated with disease progression (p = 0.03). The absence of a centralised re-review and the retrospective design represent the main limitations of our study. ConclusionsConservative management could achieve satisfactory results among T1 HG MPBC patients with neither pure MPBC nor LVI at initial diagnosis. Patient summaryBacillus Calmette-Guérin seems to be an effective therapy for T1 micropapillary bladder cancer patients with neither pure micropapillary disease nor lymphovascular invasion at initial diagnosis.

P0750 - Survival outcomes after radical cystectomy versus conservative management for clinical T1 high grade non-muscle invasive micropapillary bladder cancer: A multicenter collaboration by the European Association of Urology–Young Academic Urologists

P0750 - Survival outcomes after radical cystectomy versus conservative management for clinical T1 high grade non-muscle invasive micropapillary bladder cancer: A multicenter collaboration by the European Association of Urology–Young Academic Urologists

P106 - Micropapillary bladder cancer: A clinicopathologic characterization and treatment analysis

P106 - Micropapillary bladder cancer: A clinicopathologic characterization and treatment analysis

Clinically node-positive micropapillary bladder cancer in a young female desiring to spare functional bladder and fertility.

A 38-year-old female developing pelvic lymph node recurrence (cN2) of bladder cancer was referred to our hospital. Eighteen months earlier, she had received complete transurethral resection of bladder tumor and pathological diagnosis of muscle-invasive urothelial carcinoma with micropapillary variant had been made. She had declined radical cystectomy or chemoradiation because of a strong desire to spare the bladder and fertility. She received induction gemcitabine/cisplatin therapy. After three cycles, she achieved a clinically complete response. Then, she underwent transumbilical gasless retroperitoneoscopic super-extended pelvic lymph node dissection up to the inferior mesenteric artery trunk using the three-dimensional head-mounted display system. Pathologically, one of 42 resected lymph nodes was positive for metastasis. She is alive with no evidence of disease 5years after lymph node dissection, retaining functional bladder and normal ovarian functions.

Micropapillary bladder cancer: a clinico-pathological characterization and treatment analysis.

Micropapillary bladder cancer (MPBC) is a very rare and aggressive variant of urothelial carcinoma (UC). The aim of this study was to investigate the clinico-pathological characteristics, treatment, and prognosis of MPBC to improve the understanding of this invasive disease. We reviewed the records of 6 patients with MPBC who were evaluated and treated at our hospital between 2009 and 2015, and additionally reviewed 38 cases reported in the literature. In 44 cases, 36 cases (81.8%) were male and 8 cases (18.2%) were female, with a male:female ratio of 4.5:1; the median age of the patients was 68years (range 45-91years). A majority (81.8%) of patients with cT1 above or with lymph node and distant metastasis (cT2N0 in 18.2%, cT3-4N0 in 13.6%, cTanyN+ in 43.2%, and cTanyM+ in 6.8%). There was a high grade in 70.5% of patients. Lymphovascular invasion (LVI) was present in 61.4% of patients, and LVI in cT2 was more common than in cT1 (71.4 vs 22.2%). 52.3% of patients were treated with radical cystectomy (RC). After a mean follow-up of 16.2months, 77.3% of patients developed distant metastases, and 47.7% of patients died of the disease. The mean overall survival (OS) was 28.9months and the median OS was 20months, and the amount of micropapillary (MPP) is correlated inversely with prognosis. Micropapillary bladder cancer is a rare variant of UC associated with a poor prognosis, which often presents at an advanced stage with LVI and distant metastases. The optimal treatment strategy is early RC combined with chemotherapy.

Clinical risk stratification in patients with surgically resectable micropapillary bladder cancer.

To analyse survival in patients with clinically localised, surgically resectable micropapillary bladder cancer (MPBC) undergoing radical cystectomy (RC) with and without neoadjuvant chemotherapy (NAC) and develop risk strata based on outcome data. A review of our database identified 103 patients with surgically resectable (≤cT4acN0 cM0) MPBC who underwent RC. Survival estimates were calculated using Kaplan-Meier method and compared using log-rank tests. Classification and regression tree (CART) analysis was performed to identify risk groups for survival. For the entire cohort, estimated 5-year overall survival and disease-specific survival (DSS) rates were 52% and 58%, respectively. CART analysis identified three risk subgroups: low-risk: cT1, no hydronephrosis; high-risk: ≥cT2, no hydronephrosis; and highest-risk: cTany with tumour-associated hydronephrosis. The 5-year DSS for the low-, high-, and highest-risk groups were 92%, 51%, and 17%, respectively (P < 0.001). Patients down-staged at RC <pT1 regardless of the use of NAC had the best survival (5-year DSS of 96% vs 45% for those not down-staged; P < 0.001), while those who were not down-staged despite NAC had 5-year DSS of only 17%. In patients with surgically resectable MPBC, NAC appears to confer benefit to patients with muscle-invasive disease without hydronephrosis, while patients with cT1 disease can proceed to upfront RC. Patients with hydronephrosis do not appear to respond well to NAC and have poor prognosis regardless of treatment paradigm. However, further external validation studies are needed to support the proposed risk stratification before treatment recommendations can be made.

Micropapillary Bladder Cancer: Insights from the National Cancer Database.

Introduction: Micropapillary bladder cancer (MPBC) is a variant histology of urothelial carcinoma (UC) that is associated with poor outcomes however given its rarity, little is known outside of institutional reports. We sought to use a population-level cancer database to assess survival outcomes in patients treated with surgery, radiation therapy and/or chemotherapy.Materials and Methods: The National Cancer Database (NCDB) was queried for all cases of MPBC and UC using International Classification of Disease-O-3 morphologic codes between 2004–2014. Primary outcome was survival outcomes stratified by treatment modality. Treatments included radical cystectomy (RC) with or without neoadjuvant chemotherapy (NAC) or adjuvant chemotherapy (AC).Results: Overall 869 patients with MPBC and 389,603 patients with UC met the inclusion criteria. Median age of the MPBC cohort was 69.9 years (58.9–80.9) with the majority of the cohort presenting with high-grade (89.3%) and muscle invasive or locally advanced disease (47.6%). For cT1 MPBC, outcomes of RC and BPS were not statistically different. For≥cT2 disease, NAC showed a survival benefit compared with RC alone for UC but not for MPBC. On multivariable analysis, MPBC histology independently predicted worse increased risk of death. On subanalysis of the MPBC RC patients, NAC did not improve survival outcomes compared with RC alone.Conclusions: Neoadjuvant chemotherapy utilization and early cystectomy did not show a survival benefit in patients with MPBC. This histology independently predicts decreased survival and prognosis is poor regardless of treatment modality. Further research should focus on developing better treatment options for this rare disease.

Genomic landscape of micropapillary nonmuscle-invasive bladder cancer.

e16028Background: High grade T1 (HGT1) nonmuscle-invasive bladder cancer (NMIBC) represents a challenging and clinically heterogeneous subset of bladder cancer. Micropapillary carcinomas (MC), a ra...