You have accessJournal of UrologyBladder Cancer: Invasive II1 Apr 20121593 CLINICAL MANAGEMENT OF MUSCLE INVASIVE MICROPAPILLARY BLADDER CANCER Joshua Meeks, Jennifer Taylor, Harry Herr, S. Machele Donat, Bernard Bochner, and Guido Dalbagni Joshua MeeksJoshua Meeks New York, NY More articles by this author , Jennifer TaylorJennifer Taylor New York, NY More articles by this author , Harry HerrHarry Herr New York, NY More articles by this author , S. Machele DonatS. Machele Donat New York, NY More articles by this author , Bernard BochnerBernard Bochner New York, NY More articles by this author , and Guido DalbagniGuido Dalbagni New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1366AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES High grade urothelial carcinoma may have divergent histologic variants, among the most aggressive is micropapillary (MP) type. So aggressive, that some advocate early cystectomy for muscle invasive (MI) MP forgoing the potential benefits of neoadjuvant chemotherapy. Our goal was to determine the response of MI MP bladder cancer to neoadjuvant chemotherapy. METHODS Eighty-two patients were treated at Memorial Sloan-Kettering Cancer Center with MI bladder cancer with MP histology and were clinical stage T2 or greater. After exclusion for metastatic disease at presentation, MP first identified at radical cystectomy, and patients with significant medical comorbidities unfit for surgery, 49 patients were identified with MP diagnosed at TUR. MP histology was diagnosed at time of first presentation with T2 disease in 39 (80%) while 10 (20%) were initially diagnosed as T1 and later progressed to MI. RESULTS Of the 49 patients with MI MP, 88% were male, 72% were smokers, 90% were Caucasian with a median age of 73. MP was associated with CIS in 44% and vascular invasion was present in 30% of TURs. Neoadjuvant chemotherapy was initiated in 31 (62%) of patients. One patient had progression during neoadjuvant chemotherapy and was unable to undergo cystectomy. Radical cystectomy was performed in 43 (86%), while two were managed by TUR alone and two underwent partial cystectomy. Perineural invasion was present in 28%, CIS in 58%, lymphovascular invasion in 36%. Soft tissue margins were positive in 6%, urothelial margins in 4%. Final cystectomy pathology revealed 42% with <pT2 (pT0/T1/Tis), pT2 in 16%, pT3 in 40% and pT4 in 2%. Lymph nodes were positive in 34%. After cystectomy, 34% recurred and 34% died of bladder cancer. Overall, the rate of recurrence was no different after neoadjuvant chemotherapy (42% vs. 27%, p<0.3) and there was no difference in cancer-specific survival (39% vs 27%, p=0.3) or the rate of nodal metastasis (35% vs. 31%, p=0.2). Down-staging occurred in 48% of those that underwent neoadjuvant chemotherapy to pT0, pT1 or pTis with 27% that were pT0. If down-staging occurred, recurrence after cystectomy (21% vs. 48%, p<0.07), and cancer-specific mortality (24% vs. 77%, p<0.1) were improved. CONCLUSIONS Our retrospective data demonstrate that almost half of patients with MI MP do respond to neoadjuvant chemotherapy, with a downstaging rate similar to that reported in other studies. Progression on chemotherapy remains a risk and these patients may benefit from interim restaging. An opportunity is present for a trial comparing outcomes with or without neoadjuvant chemotherapy in this high-risk population. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e644-e645 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joshua Meeks New York, NY More articles by this author Jennifer Taylor New York, NY More articles by this author Harry Herr New York, NY More articles by this author S. Machele Donat New York, NY More articles by this author Bernard Bochner New York, NY More articles by this author Guido Dalbagni New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...