Clinical Outcomes of Patients with Histologic Variants of Urothelial Cancer Treated with Trimodality Bladder-sparing Therapy

Ross E Krasnow; Michael Drumm; Hannah J Roberts; Andrzej Niemierko; Chin-Lee Wu; Shulin Wu; Jing Zhang; Niall M Heney; Matthew F Wszolek; Michael L Blute; Adam S Feldman; Richard J Lee; Anthony L Zietman; William U Shipley; Jason A Efstathiou

doi:10.1016/j.eururo.2016.12.002

Clinical Outcomes of Patients with Histologic Variants of Urothelial Cancer Treated with Trimodality Bladder-sparing Therapy

Eur Urol. 2017 Jul;72(1):54-60. doi: 10.1016/j.eururo.2016.12.002. Epub 2016 Dec 28.

Authors

Affiliations

¹ Department of Urology, Massachusetts General Hospital. Harvard Medical School, Boston, MA, USA.
² Department of Radiation Oncology, Massachusetts General Hospital. Harvard Medical School, Boston, MA, USA.
³ Department of Pathology, Massachusetts General Hospital. Harvard Medical School, Boston, MA, USA.
⁴ Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital. Harvard Medical School, Boston, MA, USA.
⁵ Department of Radiation Oncology, Massachusetts General Hospital. Harvard Medical School, Boston, MA, USA. Electronic address: [email protected].

PMID: 28040351
DOI: 10.1016/j.eururo.2016.12.002

Abstract

Background: Trimodality bladder-sparing therapy (TMT) is an acceptable treatment for selected patients with muscle-invasive urothelial cancer. Outcomes of TMT in histologic variants remains largely unknown.

Objective: To compare outcomes of pure urothelial carcinoma (PUC) to variant urothelial carcinoma (VUC) after TMT.

Design, setting, and participants: Retrospective study of patients treated with TMT at a single cancer center from 1993 until 2013.

Outcome measurements and statistical analysis: Kaplan-Meier survival probabilities, and univariate and multivariable Cox regression analysis.

Results and limitations: Of 303 patients treated with TMT, 66 (22%) had VUC. Fifty (76%) had VUC with squamous and/or glandular differentiation and 16 (24%) had other forms. Complete response rate after induction TMT was 83% in PUC and 82% in VUC (p=0.9). The 5-yr and 10-yr disease-specific survival (DSS) was 75% and 67% in PUC versus 64% and 64% in VUC. The 5-yr and 10-yr overall survival (OS) was 61% and 42% in PUC versus 52% and 42% in VUC. On multivariable analysis VUC was not associated with DSS (hazard ratio: 1.3, 95% confidence interval: 0.8-2.2, p=0.3) or OS (hazard ratio: 1.2, 95% confidence interval: 0.8-1.7, p=0.4). Salvage cystectomy rates were similar (log-rank p=0.3). Limitations include retrospective design and restriction to variants of urothelial cancer.

Conclusions: VUC responded to TMT, and there was no significant difference in complete response, OS, DSS, or salvage cystectomy rates compared with PUC. The presence of VUC should not exclude patients from TMT.

Patient summary: The response of histologic variants of bladder cancer to bladder-sparing chemoradiation is largely unknown. We compared the outcomes of histologic variants of urothelial cancer to pure urothelial cancer in a large series of patients from a single institution. We found that variant histology does not significantly influence outcomes.

Keywords: Bladder cancer; Chemotherapy; Combined-modality therapy; Cystectomy; Histology; Outcomes; Radiation therapy; Trimodality therapy.

MeSH terms

Aged
Boston
Carcinoma / mortality
Carcinoma / pathology
Carcinoma / therapy*
Chemoradiotherapy, Adjuvant* / adverse effects
Chemoradiotherapy, Adjuvant* / mortality
Cystectomy* / adverse effects
Cystectomy* / mortality
Disease Progression
Disease-Free Survival
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Multivariate Analysis
Neoplasm Invasiveness
Proportional Hazards Models
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
Urinary Bladder Neoplasms / mortality
Urinary Bladder Neoplasms / pathology
Urinary Bladder Neoplasms / therapy*
Urothelium* / pathology