Sarcomatoid Urothelial Carcinoma: A Population-Based Study of Clinicopathologic Characteristics and Survival Outcomes

Diamantopoulos, Leonidas; Korentzelos, Dimitrios; Alevizakos, Michail; Wright, Jonathan L.; Grivas, Petros; Appleman, Leonard Joseph

doi:10.1016/j.clgc.2021.12.015

Cited by 9 publications

(9 citation statements)

References 16 publications

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“…It is also aggressive cancer with a terrible prognosis, as only a few individuals surviving for more than two years ( 26 , 27 ). Presence of sarcomatoid histology was independently associated with shorter disease-specific survival (DSS) in comparison with conventional UC (DSS: 16 months vs. 82 months) ( 28 ). Due to the rarity of this variety, current evidence on suggested therapy and oncologic outcomes in patients with sarcomatoid features is limited, with case reports/series and retrospective cohorts providing most of the information.…”

Section: Discussionmentioning

confidence: 99%

Case report: Significant benefits of tislelizumab combined with anlotinib in first-line treatment of metastatic renal pelvic urothelial carcinoma with sarcomatoid carcinoma differentiation

Zhu

Yu²,

Wang³

et al. 2022

Front. Oncol.

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BackgroundRenal pelvic urothelial carcinoma with sarcomatoid carcinoma differentiation is a very dangerous malignant tumor and extremely rare in clinical practice. In general, these tumors with a dismal prognosis, and there is no standard treatment.Case presentationIn this case, an 81-year-old male patient was diagnosed with right renal pelvic carcinoma. After an open right radical nephroureterectomy, postoperative pathological examination showed infiltrating urothelial carcinoma with sarcomatoid differentiation. Overexpression of programmed death ligand-1 by immunohistochemistry. The carcinoma recurred 4.5 months after surgery. After informed, tislelizumab combined with anlotinib were used as first-line treatment. The patients showed a clinical partial response that lasted for 20 months.ConclusionThis case demonstrates the efficacy of tislelizumab combined with anlotinib in patients diagnosed with metastatic renal pelvic urothelial carcinoma with sarcomatoid carcinoma differentiation. Moreover, to our knowledge, this is the first application of this treatment.

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Section: Discussionmentioning

confidence: 99%

Case report: Significant benefits of tislelizumab combined with anlotinib in first-line treatment of metastatic renal pelvic urothelial carcinoma with sarcomatoid carcinoma differentiation

Zhu

Yu²,

Wang³

et al. 2022

Front. Oncol.

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“…Other existing studies addressing mSBC relied on substantially smaller sample sizes (from 4 to 55 patients) [ 13 – 16 ]. Specifically, two large-scale population-based studies by Diamantopoulos et al [ 15 ] and Sui et al [ 16 ] described the second and the third ever reported mSBC cohorts, that respectively included 55 and 40 patients. However, neither addressed chemotherapy rates or chemotherapy efficacy.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of chemotherapy on overall survival in metastatic sarcomatoid bladder cancer patients

Tappero

Sorce

Panunzio

et al. 2022

Cent european J Urol

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Introduction The role of chemotherapy in metastatic sarcomatoid bladder cancer (mSBC) is unknown. The current work aimed to test the effect of chemotherapy on overall survival (OS) in mSBC patients. Material and methods Using the Surveillance, Epidemiology and End Results database (2001–2018), we identified 110 mSBC patients of all T and N stages (T any N any M 1 ). Kaplan-Meier plots and Cox regression models were used. Covariates consisted of type of surgical treatment (no treatment vs radical cystectomy vs other), and patient age. The endpoint of interest was OS. Results In 110 mSBC patients, 46 (41.8%) were exposed to chemotherapy vs 64 (58.2%) who were chemotherapy naive. Chemotherapy exposed patients were younger (median age 66 vs 70, p = 0.005). Median OS was 8 months in chemotherapy exposed vs 2 months in chemotherapy naive patients. In univariable Cox regression models, chemotherapy exposure was associated with a hazard ratio (HR) of 0.58 (p = 0.007). In multivariable Cox regression models adjusted for case mix, chemotherapy exposure was associated with a HR of 0.60 (p = 0.016). Conclusions To the best of our knowledge, this is the first report of chemotherapy effect on OS in mSBC patients. OS is extremely poor. Nonetheless, it is improved in a statistically significant and clinically meaningful fashion, when chemotherapy is administered.

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“…The epithelial component consists of urothelial carcinoma in most cases (56). Occurrence is associated with prior pelvic irradiation and intravesical cyclophosphamide therapy (57). Almassi et al (11) assessed pathologic response to NAC and survival outcomes after RC in this histologic variant.…”

Section: Sarcomatoidmentioning

confidence: 99%

Overview of histologic variants of urothelial carcinoma: current trends and narrative review on treatment outcomes

Ogbue

Haddad²,

Almassi³

et al. 2022

Transl Androl Urol

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Background and Objective: The histologic variants of urothelial carcinoma (UC) are tumors arising from within the urothelium in which some component of the tumor morphology is other than urothelial.They are underdiagnosed, aggressive and have varying pathologic response rates to systemic chemotherapy.There are no consensus guidelines on the use of systemic chemotherapy in variant histology (VH) of UC. We performed a contemporary review on pathologic response rates to neoadjuvant systemic therapy and survival outcomes following radical cystectomy in order to provide a rationale for clinical practice recommendations on the management of UC with VH.Methods: A PubMed literature search was conducted for all English articles from inception reporting either pathological response rates to neoadjuvant treatment or survival outcomes after radical cystectomy in non-metastatic VH of UC.Key Content and Findings: Neoadjuvant chemotherapy (NAC) prior to radical cystectomy was shown to be a beneficial treatment strategy in UC with VH. The micropapillary, plasmacytoid, nested and sarcomatoid histologic variants were associated with worse survival outcomes compared to conventional UC and UC with squamous or glandular differentiation despite initial downstaging with chemotherapy. There is evidence of improved survival in patients with sarcomatoid differentiation receiving NAC compared to RC alone. The major prognostic factors that affect survival outcomes in VH of UC include histologic variant subtype, patient age, presence of lymphovascular invasion, hydronephrosis, nodal metastasis and advanced T stage at diagnosis. Recent studies demonstrate that VH of UC are heterogenous tumors and responsiveness to NAC may be a function of the molecular subtypes present.Conclusions: Based on these findings, NAC to achieve pathologic downstaging prior to radical cystectomy is recommended for MIBC with VH. Biomarkers identified by molecular profiling with immunohistochemistry will need to be validated as predictors of response to NAC in future trials.

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Sarcomatoid Urothelial Carcinoma: A Population-Based Study of Clinicopathologic Characteristics and Survival Outcomes

Cited by 9 publications

References 16 publications

Case report: Significant benefits of tislelizumab combined with anlotinib in first-line treatment of metastatic renal pelvic urothelial carcinoma with sarcomatoid carcinoma differentiation

Case report: Significant benefits of tislelizumab combined with anlotinib in first-line treatment of metastatic renal pelvic urothelial carcinoma with sarcomatoid carcinoma differentiation

Efficacy of chemotherapy on overall survival in metastatic sarcomatoid bladder cancer patients

Overview of histologic variants of urothelial carcinoma: current trends and narrative review on treatment outcomes

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