Impact of Variant Histology on Occult Nodal Metastasis after Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: A Review of the National Cancer Database

Fu, Melinda Z.; Klose, Charles; Sparks, Andrew; Whalen, Michael J.

doi:10.1016/j.clgc.2021.11.011

Cited by 5 publications

(6 citation statements)

References 26 publications

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“…They showed that patients with VHs had a higher risk of recurrence and shorter median time to recurrence than those with pure UC, especially in the subgroup of patients with <pT2 disease at final pathological report [21]. Fu et al [22] queried the NCDB as a non‐IPD cohort to investigate how VHs impacted on pathological primary site and nodal downstaging after multi‐agent NAC. They found that the VH group was more likely to have ypN‐positive disease (26% vs 18%) and to be ypN2/3 ( P < 0.001).…”

Section: Discussionmentioning

confidence: 99%

“…After accounting for other variables, plasmacytoid and smallcell VH remained associated with worse DSS in multivariable analysis. A comparison with previous studies considering the incidence and survival outcomes at the multivariable level is summarized in Table 3 [9][10][11]17,21,22]. By relying on Weibull regression, Martini et al [21] aimed to create a personalized follow-up scheme of patients who harboured VHs after RC.…”

Section: Discussionmentioning

confidence: 99%

“…They found that the VH group was more likely to have ypN‐positive disease (26% vs 18%) and to be ypN2/3 ( P < 0.001). For survival analysis purposes, the authors grouped all the VHs into one cohort, resulting in a significantly increased adjusted overall mortality risk at 5 years after RC [22]. In the present study, we relied on IPD from a large multi‐institutional dataset using a dedicated pathology review capturing more VHs than in the previous literature (Table 3).…”

Section: Discussionmentioning

confidence: 99%

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Prognostic impact of variant histologies in urothelial bladder cancer treated with radical cystectomy

et al. 2023

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To evaluate variant histologies (VHs) for disease-specific survival (DSS) in patients with invasive urothelial bladder cancer (BCa) undergoing radical cystectomy (RC). Materials and MethodsWe analysed a multi-institutional cohort of 1082 patients treated with upfront RC for cT1-4aN0M0 urothelial BCa at eight centres. Univariable and multivariable Cox' regression analyses were used to assess the effect of different VHs on DSS in overall cohort and three stage-based analyses. The stages were defined as 'organ-confined' (≤pT2N0), 'locally advanced' (pT3-4N0) and 'node-positive' (pTanyN1-3). ResultsOverall, 784 patients (72.5%) had pure urothelial carcinoma (UC), while the remaining 298 (27.5%) harboured a VH. Squamous differentiation was the most common VH, observed in 166 patients (15.3%), followed by micropapillary (40 patients [3.7%]), sarcomatoid (29 patients [2.7%]), glandular (18 patients [1.7%]), lymphoepithelioma-like (14 patients [1.3%]), small-cell (13 patients [1.2%]), clear-cell (eight patients [0.7%]), nested (seven patients [0.6%]) and plasmacytoid VH (three patients [0.3%]). The median follow-up was 2.3 years. Overall, 534 (49.4%) disease-related deaths occurred. In uni-and multivariable analyses, plasmacytoid and small-cell VHs were associated with worse DSS in the overall cohort (both P = 0.04). In univariable analyses, sarcomatoid VH was significantly associated with worse DSS, while lymphoepithelioma-like VH had favourable DSS compared to pure UC. Clear-cell (P = 0.015) and small-cell (P = 0.011) VH were associated with worse DSS in the organ-confined and node-positive cohorts, respectively.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Prognostic impact of variant histologies in urothelial bladder cancer treated with radical cystectomy

et al. 2023

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“…Additionally, an analysis of the National Cancer Database also revealed that occult regional LN metastasis in patients with pCR depends on the variant histology of BC. Neuroendocrine histology has the lowest risk of persistent LN disease, which could have implications for post-chemiotherapy management [ 37 ]. In contrast, Kaag et al found that no patients who achieved stage ypT0 after NAC had LN involvement at RC or recurrence within the regional LN template.…”

Section: Discussionmentioning

confidence: 99%

Adequate Pelvic Lymph Node Dissection in Radical Cystectomy in the Era of Neoadjuvant Chemotherapy: A Meta-Analysis and Systematic Review

Kaczmarek

Małkiewicz

Lemiński

2023

Cancers

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Radical cystectomy (RC) with pelvic lymphadenectomy (PLND) serves as the gold-standard treatment for muscle-invasive bladder cancer (MIBC). Numerous studies have shown that the number of lymph nodes (LN) removed during RC could affect patient prognosis. However, these studies confirmed the association between PLND and survival outcomes prior to the widespread adoption of neoadjuvant chemotherapy (NAC). Consequently, this study aimed to investigate the prognostic role of PLND in patients previously pretreated with NAC. A systematic review and meta-analysis were performed using PubMed, Web of Knowledge, and Scopus databases. The selected studies contained a total of 17,421 participants. The meta-analysis indicated a significant correlation between adequate PLND and overall survival in the non-NAC group. However, a survival benefit was not observed in patients undergoing RC with preoperative systemic therapy, regardless of the LN cut-off thresholds. The pooled HR for ≥10 and ≥15 LN were 0.87 (95% CI 0.75–1.01) and 0.87 (95% CI 0.76–1.00), respectively. The study results suggest that NAC mitigates the therapeutic significance of PLND, as patients pre-treated with NAC no longer gain oncological benefits from more extensive lymphadenectomy. This highlights the analogous roles of NAC and PLND in eradication of micrometastases and in prevention of distal recurrence post-RC.

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“…Recently, Fu et al [28], analysing a large multicentre dataset of 5335 cT2-4N0M0 BCa patients from the NCDB treated with NAC and radical cystectomy, compared pUC (92%) versus variant histology patients (8%), including squamous, glandular, micropapillary ( n = 73; 17%), small cell, and sarcomatoid variants. At multivariable Cox analyses, micropapillary differentiation was not an independent predictor of pathologically complete downstaging (pT0) or pathological downstaging to pT 1 or less compared with pUC.…”

Section: Evidence Synthesismentioning

confidence: 99%

Micropapillary bladder cancer: an evolving biology

Lonati

Simeone

Suardi

et al. 2022

Current Opinion in Urology

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Purpose of reviewTo summarize a comprehensive overview of more recent evidence on micropapillary bladder cancer (MPBC), focusing on actual incidence, clinical features, therapeutic strategies, and prognosis.Recent findingsMPBC 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).SummaryThe 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.

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Impact of Variant Histology on Occult Nodal Metastasis after Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: A Review of the National Cancer Database

Cited by 5 publications

References 26 publications

Prognostic impact of variant histologies in urothelial bladder cancer treated with radical cystectomy

Prognostic impact of variant histologies in urothelial bladder cancer treated with radical cystectomy

Adequate Pelvic Lymph Node Dissection in Radical Cystectomy in the Era of Neoadjuvant Chemotherapy: A Meta-Analysis and Systematic Review

Micropapillary bladder cancer: an evolving biology

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