Contemporary treatment patterns and outcomes of sarcomatoid bladder cancer

Sui, Wilson; Matulay, Justin T.; Onyeji, Ifeanyi; Theofanides, Marissa C.; James, Maxwell B.; RoyChoudhury, Arindam; Wenske, Sven; DeCastro, G. Joel

doi:10.1007/s00345-016-1962-8

Cited by 40 publications

(43 citation statements)

References 23 publications

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“…Because it is known that this rare variant histology is generally more aggressive and is at a more advanced stage at the time of diagnosis, 21 an immediate RC is recommended as firstline therapy, because neither neoadjuvant chemotherapy nor AC has been observed to improve overall survival. 22,23 In contrast to our findings in multivariable landmark Cox regression analysis, Siefker-Radtke and Dinney described the benefit of chemotherapy for small cell bladder cancer, which is a subtype of neuroendocrine tumors. 9 The chemosensitivity of neuroendocrine tumors has been previously described.…”

Section: Discussioncontrasting

confidence: 99%

“…For patients with sarcomatoid differentiation, our findings align with the current literature. Because it is known that this rare variant histology is generally more aggressive and is at a more advanced stage at the time of diagnosis, an immediate RC is recommended as first‐line therapy, because neither neoadjuvant chemotherapy nor AC has been observed to improve overall survival …”

Section: Discussionmentioning

confidence: 99%

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Impact of adjuvant chemotherapy in patients with adverse features and variant histology at radical cystectomy for muscle‐invasive carcinoma of the bladder: Does histologic subtype matter?

Trinh

D’Andrea

Vetterlein

et al. 2019

Cancer

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Background The use of adjuvant chemotherapy (AC) in pure urothelial carcinoma of the bladder is established. Regarding variant histology, there is a gap in knowledge concerning the optimal treatment after radical cystectomy (RC). The objective of this study was to assess the effect of AC on overall survival (OS) in patients who had pure urothelial carcinoma, urothelial carcinoma with concomitant variant histology, or another pure variant histology. Methods Within the National Cancer Data Base, 15,397 patients who underwent RC for nonmetastatic, localized carcinoma of the bladder and had positive lymph nodes (T2N+) or locally advanced stage (≥T3N0/N+) were identified, excluding those who had previously received neoadjuvant chemotherapy. Multivariable Cox regression models were used to examine the specific effect of AC on OS stratified by each distinct histologic subtype, including pure urothelial carcinoma, micropapillary or sarcomatoid differentiation, squamous cell carcinoma, adenocarcinoma, and neuroendocrine tumors. To account for immortal time bias, Cox regression analyses and Kaplan‐Meier analyses were conducted with a landmark at 3 months. Results In multivariable landmark analyses, AC compared with initial observation was associated with an OS benefit for patients who had pure urothelial carcinoma (hazard ratio, 0.87; 95% confidence interval, 0.82‐0.91), whereas no differences were observed with regard to those who had variant histology. Conclusions Multivariable Cox regression landmark analysis revealed a survival benefit from AC for patients with a pure urothelial carcinoma. However, a survival benefit of AC for patients who had urothelial carcinoma with concomitant variant histology or other pure variant histology was not demonstrated.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of adjuvant chemotherapy in patients with adverse features and variant histology at radical cystectomy for muscle‐invasive carcinoma of the bladder: Does histologic subtype matter?

Trinh

D’Andrea

Vetterlein

et al. 2019

Cancer

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“…Sarcomatoid variant is an aggressive component of mixed tumors. The prognosis of these patients is generally poor, and data from the National Cancer Database suggests that aggressive treatment with RC is needed, but the role of multimodal therapy is uncertain [22]. Interestingly, it has been described that a higher amount of variant histology in RC specimens is seen after NAC than in transurethral resection of bladder tumor (TURBT) specimens; however, the percentage of variant histology on TURBT specimen was not associated with NAC pathological response.…”

Section: Pathological Classificationmentioning

confidence: 99%

Predicting Response to Neoadjuvant Chemotherapy in Bladder Cancer

Motterle

Andrews

Morlacco

et al. 2020

European Urology Focus

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“…15 The detection of SAV-BC generally portends a poor prognosis based on a more advanced stage at diagnosis and worse OS. 10 Patients with RHV-BC had a higher proportion of advanced stage and worse prognosis than those with pure bladder cancer. 2 It is critical to make decisions upon the management.…”

Section: Discussionmentioning

confidence: 97%

<p>Clinical Characteristics and Prognosis of Rare Histological Variants of Bladder Cancer: A Single-Center Retrospective Study from China</p>

Li¹,

Li²,

Yang³

et al. 2020

CMAR

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To investigate the clinical characteristics and prognosis of patients with rare histological variants of bladder cancer (RHV-BC) in China. Materials and Methods: Patients diagnosed as bladder carcinoma with RHV in our center, from March 2009 and April 2019, were included. The univariate and multivariate COX regression model were used to evaluate the association between clinical characteristics and overall survival (OS). Results: A total of 54 (1.4%) patients with RVH-BC were identified from 3803 potential patients with bladder cancer. The RHV classifications included micropapillary variant (MPV), sarcomatoid variant (SAV), neuroendocrine variant (NEV), nested variant (NV), plasmacytoid variant (PCV), and lymphoepithelioma-like variant (LEV), which were found in 19, 18, seven, six, three, and one patient, respectively. The mean of recurrence-free survival (RFS), cancer-specific survival (CSS), and OS of patients were 18.8 months, 37.0 months and 36.0 months, respectively. The multivariable analyses indicated that metastasis and T ≥2 were independent risk factors of OS. Besides, 84.4% (27/32) of patients who were receiving intravesical therapies (IVT) suffered recurrence. Patients with adjuvant chemotherapy (AC) had a recurrence rate of 64.7% (11/17). Conclusion: T≥2 and metastasis were independent risk factors of OS in patients with RHV-BC. Considering a high recurrence following transurethral resection of bladder tumor (TURBT) and IVT, early radical cystectomy (RC) might be performed for patients with RHV-BC.

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Contemporary treatment patterns and outcomes of sarcomatoid bladder cancer

Cited by 40 publications

References 23 publications

Impact of adjuvant chemotherapy in patients with adverse features and variant histology at radical cystectomy for muscle‐invasive carcinoma of the bladder: Does histologic subtype matter?

Impact of adjuvant chemotherapy in patients with adverse features and variant histology at radical cystectomy for muscle‐invasive carcinoma of the bladder: Does histologic subtype matter?

Predicting Response to Neoadjuvant Chemotherapy in Bladder Cancer

<p>Clinical Characteristics and Prognosis of Rare Histological Variants of Bladder Cancer: A Single-Center Retrospective Study from China</p>

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