Significance of Perioperative Chemotherapy in Squamous Cell Carcinoma of the Upper and Lower Urinary Tract

Abstract

Abstract. Background Although urothelial carcinoma (UC) represents the majority of bladder tumours, with rates ranging between 90% and 95%, bladder cancer encompasses a wide spectrum of malignancies including squamous cell carcinoma (SCC; 2-5%), adenocarcinoma (0.5-2%), small cell carcinoma (<1%) and other less common histological types (1). In contrast, SCC represents 1-2% of all upper urinary tract (UT) cancers; thus, establishing a standard of care for SCC is difficult and the prognosis remains poor due to the paucity of cases (2).In this retrospective study, we evaluated the association between SCC of the upper and lower UT cases and oncological outcomes. We also surveyed the utility of perioperative chemotherapy in these cases. Patients and MethodsFor this institutional review board-approved retrospective study at the Kanazawa University, the medical records of 33 patients diagnosed with SCC in renal pelvis, ureter and bladder between 2007 and 2017 were included. We analysed cancer-specific survival (CSS) according to cancer stage, which was determined according to the TNM classification by the International Union Against Cancer (3). Histological type was determined according to the 2004 definition of the World Health Organization (4). Clinicopathological variables that were recorded included patient age, gender, tumour location, tumour T stage, lymph node (LN) status, presence of distant metastases, metastatic sites, cancer stage and histologic type (i.e. pure SCC or UC with squamous differentiation (UCSD)). In the present study, seven patients received presurgical treatment such as cisplatin-based chemotherapy including methotrexate/vinblastine/ doxorubicin/cisplatin (MVAC) or gemcitabine/cisplatin (GC) regimen. A grading system of histological response to neoadjuvant therapy for evaluation of both host reactions to tumour destruction and cytologic changes of tumour cells has been reported in various cancer types such as breast cancer; however, its utility in UC is unclear. Therefore, in this study, we utilized the grading system established for breast cancer to evaluate the efficacy of neoadjuvant chemotherapy (NAC). Overall survival (OS) and disease-free survival (DFS) rates were calculated from the date of diagnosis to death or last follow-up and occurrence of local or distant metastasis, respectively. Survival curves were calculated by the Kaplan-Meier method, and differences in survival between the groups according to the cancer stage were compared by log-rank test. Continuous variables were analysed using the Mann-Whitney U-test, and categorical variables were compared using the χ 2 or Fisher's exact test. All tests with a two-sided p-value of <0.05 were considered statistically significant. All statistical analyses were performed using Prism 6 (GraphPad ® , USA). 2241

The Impact of Histological Variant on Oncological Outcomes in Patients With Urothelial Carcinoma of the Bladder Treated With Radical Cystectomy

“…In addition, the prevalence of HV has increased consistently during the years. Indeed, Marco et al (10) (6). Shah et al (13) reported that 44% of HV were not recognized by referring institutions.…”

Squamous or Glandular Differentiation Predicts Poor Prognosis in pT1 Urothelial Carcinoma

“…Mitra et al found that UCSD and UCGD have a significantly more advanced clinical stage upon diagnosis compared with PUC and are associated with poor prognosis (7). For chemotherapy, there are both reports of similar response to PUC and reports showing worse response (3,8,9). Although many studies on the prognosis of muscleinvasive BC with VH have been conducted, only a few have focused on pathological T1 (pT1) cases of invasion of the lamina propria.…”