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. 2020;6(1):71-81.
doi: 10.3233/blc-190258. Epub 2020 Mar 28.

Plasmacytoid urothelial carcinoma: response to chemotherapy and oncologic outcomes

Leonidas N Diamantopoulos  1 , Ali Raza Khaki  1 , Petros Grivas  1   2 , John L Gore  3 , George R Schade  3 , Andrew C Hsieh  1   2 , John K Lee  1   2 , Todd Yezefski  1 , Evan Y Yu  1   2 , Michael T Schweizer  1   2 , Heather H Cheng  1   2 , Sarah P Psutka  3 , Daniel W Lin  2   3 , Maria S Tretiakova  4 , Funda Vakar-Lopez  4 , Robert B Montgomery  1   2 , Jonathan L Wright  2   3
Affiliations

Plasmacytoid urothelial carcinoma: response to chemotherapy and oncologic outcomes

Leonidas N Diamantopoulos et al. Bladder Cancer. 2020.

Abstract

Background: Plasmacytoid urothelial carcinoma is a rare bladder cancer variant with scarce data on outcomes and prognostic factors.

Objective: We report our institutional experience with this histology to determine response to neoadjuvant chemotherapy, definitive surgery and survival.

Methods: We conducted a retrospective chart review of consecutive patients with plasmacytoid, as well as conventional urothelial carcinoma (for comparison) seen in our institution (2007 - 2018). Baseline characteristics, clinicopathologic and treatment data were captured. T-test, chi-squared and log-rank test was used for group comparison. Kaplan Meier method was used for estimation of overall survival and Cox regression for identification of prognostic factors.

Results: 64 patients with plasmacytoid and 418 with conventional urothelial histology were identified; 53% of those with plasmacytoid presented with cT3/4 stage and 67% underwent extirpative surgery. Patients with plasmacytoid histology had higher rates of pT3/4 (65% vs. 28%), nodal disease (37% vs. 16%) and positive surgical margins (23% vs. 5%) compared to urothelial group (p < 0.01), as well as higher incidence of post-operative recurrence (47% vs. 29%, p = 0.05) and lower ypT0N0 rates after neoadjuvant chemotherapy (10% vs. 33%, p = 0.03). Plasmacytoid histology was associated with lower median overall survival compared to conventional urothelial (24 vs. 154 months, p < 0.01).

Conclusions: Plasmacytoid urothelial carcinoma frequently presented with advanced stage at diagnosis and extirpative surgery, poor pathologic response to neoadjuvant chemotherapy, and inferior outcomes, when compared to conventional urothelial. Prospective trials evaluating upfront cystectomy versus preoperative chemotherapy and/or novel treatments should be considered.

Keywords: cystectomy; neoadjuvant therapy; transitional cell carcinoma; urinary bladder neoplasms.

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Conflict of interest statement

Conflict of Interest Statement Leonidas Nikolaos Diamantopoulos No Relationships to Disclose Ali Raza Khaki Stock and Other Ownership Interests - Pfizer; Procter & Gamble; Walgreens Boots Alliance Petros Grivas: personal fees and other from Genentech, personal fees and other from Bayer, personal fees and other from Merck & Co., personal fees and other from Mirati Therapeutics, other from Oncogenex, personal fees and other from Pfizer, personal fees and other from Bristol-Myers Squibb, personal fees, non-financial support and other from Astra Zeneca, personal fees from Biocept, personal fees, non-financial support and other from ClovisOncology, personal fees from EMD Serono, personal fees from Seattle Genetics, personal fees from Foundation Medicine, personal fees from Driver Inc., personal fees from QED Therapeutics, personal fees from Heron Therapeutics, personal fees from Janssen, other from Bavarian Nordic, other from Immunomedics, other from Debiopharm, personal fees from GlaxoSmithKline, personal fees from Roche, personal fees from Genzyme, personal fees from Exelixis. John L. Gore Research Funding – Ferring Pharmaceuticals George R Schade Patents, Royalties, Other Intellectual Property - Global Cancer Technology Andrew Caleb Hsieh Honoraria - Hotspot Therapeutics Research Funding - eFFECTOR Inc Patents, Royalties, Other Intellectual Property - MTOR modulators and uses thereof Patent number: 9629843; USE OF TRANSLATIONAL PROFILING TO IDENTIFY TARGET MOLECULES FOR THERAPEUTIC TREATMENT Publication number: 20140288097 John Kyung Lee Research Funding - Immunomedics Todd Yezefski No Relationships to Disclose Evan Y. Yu Consulting or Advisory Role - Amgen; AstraZeneca; Bayer; Churchill Pharmaceuticals; Dendreon; EMD Serono; Incyte; Janssen; Merck; QED; Seattle Genetics; Tolmar Research Funding - Agensys; Astellas Pharma; Bayer; Dendreon; Genentech/Roche; Merck; Seattle Genetics Michael Thomas Schweizer Consulting or Advisory Role - Janssen Research Funding - AstraZeneca; Janssen; Madison Vaccines, Inc.; Pfizer; Roche; Zenith Epigenetics Heather H. Cheng Research Funding - Astellas Medivation; Clovis Oncology; Color Foundation; Inovio Pharmaceuticals; Janssen; Sanofi Sarah P. Psutka Honoraria - Prime Education Travel, Accommodations, Expenses - Prime Education Daniel W. Lin Consulting or Advisory Role - Astellas Pharma; Clovis Oncology; Dendreon Research Funding - GenomeDx; Genomic Health; MDxHealth Maria S. Tretiakova No Relationships to Disclose Funda Vakar-Lopez No Relationships to Disclose Robert B. Montgomery Research Funding - AstraZeneca; ESSA; Ferring; Janssen Oncology Jonathan L. Wright Speakers’ Bureau - Foundation Health Partners Carroll Cancer Center; OncLive; Seattle Cancer Care Alliance Research Funding - Altor BioScience; Merck; Nucleix Other Relationship - Movember; UpToDate

Figures

Figure 1 –
Figure 1 –
Photomicrography of bladder tumors. A – Plasmacytoid urothelial carcinoma (40x). B - Plasmacytoid urothelial carcinoma (200x). C – Plasmacytoid urothelial carcinoma with rhabdoid features (100x). D – Plasmacytoid urothelial carcinoma with signet ring features (200x). E – Conventional urothelial carcinoma (40x). F – Conventional urothelial carcinoma with muscle invasion (100x).
Figure 2 -
Figure 2 -
Overall survival (OS) from the time of diagnosis of plasmacytoid urothelial carcinoma (PUC), between surgical and non-surgical group.
Figure 3 –
Figure 3 –
Overall survival (OS) from the time of extirpative surgery for conventional (pure) urothelial carcinoma (UC) and plasmacytoid UC (PUC)
See this image and copyright information in PMC

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