You have accessJournal of UrologyBladder Cancer: Natural History & Pathophysiology1 Apr 2014MP50-06 MICROPAPILLARY DIFFERENTIATION VERSUS CONVENTIONAL UROTHELIAL CARCINOMA: EFFECTS OF NEOADJUVANT CHEMOTHERAPY AND CYSTECTOMY ON SURVIVAL Noah Canvasser, Alon Weizer, Heather Crossley, Stephen Dailey, Chang He, Lakshmi Priya Kunju, Cheryl Lee, Khaled Hafez, Brent Hollenbeck, Todd Morgan, James Montie, and Jeffrey Montgomery Noah CanvasserNoah Canvasser More articles by this author , Alon WeizerAlon Weizer More articles by this author , Heather CrossleyHeather Crossley More articles by this author , Stephen DaileyStephen Dailey More articles by this author , Chang HeChang He More articles by this author , Lakshmi Priya KunjuLakshmi Priya Kunju More articles by this author , Cheryl LeeCheryl Lee More articles by this author , Khaled HafezKhaled Hafez More articles by this author , Brent HollenbeckBrent Hollenbeck More articles by this author , Todd MorganTodd Morgan More articles by this author , James MontieJames Montie More articles by this author , and Jeffrey MontgomeryJeffrey Montgomery More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1127AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives The impact of neoadjuvant chemotherapy (NAC) on survival in patients undergoing radical cystectomy (RC) for bladder cancer with micropapillary differentiation (MP) is an area of ongoing debate. We sought to compare the long-term outcomes of MP and conventional urothelial carcinoma (UC) after RC and assess the influence of NAC on survival. Methods Demographic, pathologic, and survival data, were abstracted from an institutional review board-approved cystectomy database (1995-2008). Patients with any evidence of MP were included in the analysis. Our primary outcome was overall survival (OS), with secondary outcomes of cancer-specific (CSS) and recurrence-free survival (RFS). The log rank test and Cox proportional hazards model were used to assess survival outcomes by histology type and use of NAC. Results Of 1020 consecutive patients, 720 (70.6%) had pure UC and 41 (4.0%) had MP. NAC was administered to 16.7% vs. 29.3% of patients with UC and MP, respectively (p=0.006). Baseline data, as well as clinical stage, were similar in both groups. Patients with MP had significantly more invasive pathologically staged disease, with 63% vs. 47% demonstrating muscle invasion at the time of RC (p<0.001). MP was associated with more metastatic recurrences (p=0.01), but similar local and upper tract recurrences. In a multivariable analysis adjusting for age, gender, pathologic T stage, Karnofsky Score, and Charlson Index, MP was associated with worse CSS (HR 1.66: 95% CI 1.01-2.74; p=0.047) and RFS (HR 1.57: 1.04-2.39; p=0.03), and approached statistical significance with OS (HR 1.42: 0.91-2.23; p=0.12). In a subgroup analysis comparing MP with and without NAC, patients who received NAC had similar OS (HR 1.13: 0.42-3.04; p=0.82), CSS (HR 0.90: 0.32-2.55; p=0.84), and RFS (HR 1.23: 0.51-2.96; p=0.64). Conclusions Consistent with the known aggressive nature of MP, these data demonstrate that MP is associated with higher pathologic T stage than UC at the time of RC, as well as more significant metastatic recurrences. Additionally, MP was associated with worse CSS and RFS, while worse OS approached statistical significance. While limited by patient numbers, these data do not demonstrate any difference in outcomes with the addition of NAC in patients with MP undergoing RC. © 2014FiguresReferencesRelatedDetailsCited byMori K, Abufaraj M, Mostafaei H, Quhal F, Karakiewicz P, Briganti A, Kimura S, Egawa S and Shariat S (2020) A Systematic Review and Meta-Analysis of Variant Histology in Urothelial Carcinoma of the Bladder Treated with Radical CystectomyJournal of Urology, VOL. 204, NO. 6, (1129-1140), Online publication date: 1-Dec-2020. Volume 191Issue 4SApril 2014Page: e495-e496 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Noah Canvasser More articles by this author Alon Weizer More articles by this author Heather Crossley More articles by this author Stephen Dailey More articles by this author Chang He More articles by this author Lakshmi Priya Kunju More articles by this author Cheryl Lee More articles by this author Khaled Hafez More articles by this author Brent Hollenbeck More articles by this author Todd Morgan More articles by this author James Montie More articles by this author Jeffrey Montgomery More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...