The demographic features, clinical outcomes, prognosis and treatment options for patients with sarcomatoid carcinoma of the urinary bladder: a single centre experience

Abstract

IntroductionCarcinosarcoma of the bladder is a very rare neoplasm. The pathogenesis of carcinosarcomas is not clearly understood and remains a subject of debate. Whilst there is some research conceptualizing the histopathological findings of bladder carcinosarcomas, the demographic features, clinical outcomes, prognosis and treatment options remain unclear.Materials and MethodsWe analyzed 12 consecutive cases of patients with sarcoma-toid bladder cancer who were treated surgically at a single Urology Department be-tween 1999 and 2015. Radiology, pathology and surgical reports were reviewed to determine the pathological staging at the time of cystectomy. These were directly compared with 230 patients having cystectomies for urothelial cell carcinoma. The sarcomatoid patients, were compared to patients with urothelial cell cancers. The other histological sub types, squamous cell (17), neuroendocrine (9), metastatic (7), mixed (4), adenocarcinoma (3), were not included.Results and conclusionCarcinosarcoma of the urinary bladder is often described in the literature as a highly malignant neoplasm that is rapidly lethal. We found that the sarcoma does not offer a worse prognosis than conventional high-grade urothelial car-cinoma. There is no significant difference in grade, stage, positive surgical margin rate, nodal involvement, associated prostate cancer or incidence rates of progression, all cause or disease specific mortality. There was a barely significant difference in carcinoma in-situ. However, carcinosarcomas are three times the volume of urothelial cell tumors which may contribute to its reputation as an aggressive tumour (44cc v 14cc). Sarcomatous elements do not appear, from our small study, to bestow a worse prognosis.

Sarcomatoid variant urothelial carcinoma of the bladder: a systematic review and meta-analysis of the clinicopathological features and survival outcomes

“…Sarcomatoid variant is a rare histologic variant of UC, comprising less than 1% of all UCB. Though former evidences supported that SV-UCB was aggressive, prone to present at an advanced stage and was associated with poor long-term survival [3,8,9], many studies have denied the prognosis significance of sarcomatoid variant in UCB [10][11][12]. The behavior of SV-UCB and its treatment guidelines are not well characterized.…”

“…Of the 3 patients, 1 received neoadjuvant chemotherapy and 2 received 4 cycles of cisplatin and gemcitabine adjuvant chemotherapy. Robinson et al [ 10 ] have described multimodal treatment in 4 out of 12 patients with surgically treated SV-UCB. Two patients who received the adjuvant gemcitabine and cisplatin were still alive at 118 and 8 months, respectively.…”

“…Forty-one full-text articles were assessed for eligibility, 33 of them were excluded due to out of scope, unable to extract outcome data, non-human study. Lastly, 8 literatures were included in the present study [3,6,7,[9][10][11][12]18]. All studies were retrospective observational studies, the detailed characteristics were shown in Table 1.…”

“…3 d) were similar for patients with SV-UCB and C-UCB. For PFS, one study has reported unadjusted result [ 10 ] and one study has reported adjusted result [ 11 ]. After merging these results, we found that sarcomatoid variant had no influence on PFS for UCB (HR, 1.16; 95% CI, 0.57–2.38; p = 0.680) (Fig.…”

“…Many evidences supported that SV-UCB tended to present at an advanced stage and was associated with poor long-term survival [ 3 , 8 , 9 ]. However, single-center study failed to identify a worse prognosis when compared with conventional UCB (C-UCB) [ 10 ]. Moreover, compared with C-UCB, Moschini et al [ 11 ] and Monn et al [ 12 ] have found that sarcomatoid variant was not an independent predictor of poor prognosis.…”