Adjuvant chemotherapy is ineffective in patients with bladder cancer and variant histology treated with radical cystectomy with curative intent

Stefania Zamboni¹, Luca Afferi², Francesco Soria^{3

4}, Atiqullah Aziz⁵, Mohammad Abufaraj⁶, Cedric Poyet⁷, Andrea Necchi⁸, David D'Andrea⁹, Giuseppe Simone¹⁰, Mariaconsiglia Ferriero¹⁰, Ettore Di Trapani¹¹, Claudio Simeone¹², Alessandro Antonelli¹³, Andrea Gallina¹⁴, Francesco Montorsi¹⁴, Alberto Briganti¹⁴, Renzo Colombo¹⁴, Giorgio Gandaglia¹⁴, Agostino Mattei², Philipp Baumeister², Livio Mordasini², Kees Hendricksen¹⁵, Charlotte S Voskuilen¹⁵, Michael Rink¹⁶, Shahrokh F Shariat^{4

17

18

19}, Evanguelous Xylinas²⁰, Marco Moschini²

Affiliations

¹ Urology Unit, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy. Stefania.zamboni@libero.it.
² Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.
³ Division of Urology, Department of Surgical Sciences, University of Studies of Torino, Turin, Italy.
⁴ Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
⁵ Department of Urology, München Klinik Bogenhausen, Munich, Germany.
⁶ Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan.
⁷ Department of Urology, University Hospital Zürich, University of Zürich, Zurich, Switzerland.
⁸ Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
⁹ Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
¹⁰ Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy.
¹¹ Department of Urology, European Institute of Oncology, Milan, Italy.
¹² Urology Unit, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy.
¹³ Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
¹⁴ Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, URI, Milan, Italy.
¹⁵ Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
¹⁶ Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹⁷ Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹⁸ Department of Urology, Weill Cornell Medical College, New York, NY, USA.
¹⁹ Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
²⁰ Department of Urology Bichat Hospital, Paris Descartes University, Paris, France.

PMID: 32712850
DOI: 10.1007/s00345-020-03362-1

Adjuvant chemotherapy is ineffective in patients with bladder cancer and variant histology treated with radical cystectomy with curative intent

Stefania Zamboni et al. World J Urol. 2021 Jun.

. 2021 Jun;39(6):1947-1953.

doi: 10.1007/s00345-020-03362-1. Epub 2020 Jul 25.

Authors

Affiliations

¹ Urology Unit, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy. Stefania.zamboni@libero.it.
² Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.
³ Division of Urology, Department of Surgical Sciences, University of Studies of Torino, Turin, Italy.
⁴ Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
⁵ Department of Urology, München Klinik Bogenhausen, Munich, Germany.
⁶ Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan.
⁷ Department of Urology, University Hospital Zürich, University of Zürich, Zurich, Switzerland.
⁸ Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
⁹ Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
¹⁰ Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy.
¹¹ Department of Urology, European Institute of Oncology, Milan, Italy.
¹² Urology Unit, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy.
¹³ Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
¹⁴ Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, URI, Milan, Italy.
¹⁵ Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
¹⁶ Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹⁷ Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹⁸ Department of Urology, Weill Cornell Medical College, New York, NY, USA.
¹⁹ Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
²⁰ Department of Urology Bichat Hospital, Paris Descartes University, Paris, France.

PMID: 32712850
DOI: 10.1007/s00345-020-03362-1

Abstract

Objectives: Adjuvant chemotherapy (ACT) is recommended for non-organ-confined bladder cancer (BCa) after radical cystectomy (RC) and pelvic lymph node dissection (PLND), but there are sparse data regarding its specific efficacy in patients with histological variants. The aim of our study was to evaluate the role of ACT on survival outcomes in patients with variant histology in a large multicenter cohort.

Materials and methods: We retrospectively evaluated data of 3963 patients with BCa treated with RC and bilateral PLND with curative intent at several institutions between 1999 and 2018. The histological type was classified into six groups: pure urothelial carcinoma (PUC) or squamous, sarcomatoid, micropapillary, glandular and neuroendocrine differentiation. Multivariable competing risk analysis was applied to assess the role of ACT on recurrence and cancer-specific mortality (CSM) in each histological subtype.

Results: Of the 3963 patients included in the study, 23% had variant histology at RC specimen and 723 (18%) patients received ACT. ACT was found to be significantly associated with reduced risk of recurrence (sub-hazard ratio [SHR]: 0.55, confidence interval [CI] 0.42-0.71, p < 0.001) and CSM (SHR: 0.58, CI 0.44-0.78, p < 0.001) in the PUC only, while no histological subtype received a significant benefit on survival outcomes (all p > 0.05) from administration of ACT. The limitation of the study includes the retrospective design, the lack of a central pathology review and the number of ACT cycles.

Conclusion: In our study, the administration of ACT was associated with improved survival outcomes in PUC only. No histological subtype found a benefit in overall recurrence and CSM from ACT.

Keywords: ACT; Adjuvant chemotherapy; Bladder cancer; Radical cystectomy; Variant histology.

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References

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Adjuvant chemotherapy is ineffective in patients with bladder cancer and variant histology treated with radical cystectomy with curative intent

Affiliations

Adjuvant chemotherapy is ineffective in patients with bladder cancer and variant histology treated with radical cystectomy with curative intent

Authors

Affiliations

Abstract

References

MeSH terms

LinkOut - more resources

Full Text Sources

Medical