Premium
Neoadjuvant chemotherapy prior to radical cystectomy for muscle‐invasive bladder cancer with variant histology
Author(s) -
Vetterlein Malte W.,
Wankowicz Stephanie A. M.,
Seisen Thomas,
Lander Richard,
Löppenberg Björn,
Chun Felix K.H.,
Me Mani,
Sun Maxine,
Barletta Justine A.,
Choueiri Toni K.,
Bellmunt Joaquim,
Trinh QuocDien,
Preston Mark A.
Publication year - 2017
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.30907
Subject(s) - medicine , cystectomy , bladder cancer , hazard ratio , chemotherapy , oncology , adenocarcinoma , neoadjuvant therapy , odds ratio , cancer , proportional hazards model , urology , pathology , confidence interval , breast cancer
BACKGROUND Neoadjuvant chemotherapy in pure urothelial bladder cancer provides a significant survival benefit. However, to the authors' knowledge, it is unknown whether this benefit persists in histological variants. The objective of the current study was to assess the effect of neoadjuvant chemotherapy on the probability of non‐organ‐confined disease and overall survival after radical cystectomy (RC) in patients with histological variants. METHODS Querying the National Cancer Data Base, the authors identified 2018 patients with histological variants who were undergoing RC for bladder cancer between 2003 and 2012. Variants were categorized as micropapillary or sarcomatoid differentiation, squamous cell carcinoma, adenocarcinoma, neuroendocrine tumors, and other histology. Logistic regression models estimated the odds of non‐organ‐confined disease at the time of RC for each histological variant, stratified by the receipt of neoadjuvant chemotherapy. Cox regression models were used to examine the effect of neoadjuvant chemotherapy on overall mortality in each variant subgroup. RESULTS Patients with neuroendocrine tumors (odds ratio [OR], 0.16; 95% confidence interval [95% CI], 0.08‐0.32 [ P <.001]), micropapillary differentiation (OR, 0.30; 95% CI, 0.10‐0.95 [ P= .041]), sarcomatoid urothelial carcinoma (OR, 0.40; 95% CI, 0.17‐0.94 [ P= .035]), and adenocarcinoma (OR, 0.24; 95% CI, 0.06‐0.91 [ P= .035]) were less likely to harbor non‐organ‐confined disease at the time of RC when treated with neoadjuvant chemotherapy. An overall survival benefit for neoadjuvant chemotherapy was only found in patients with neuroendocrine tumors (hazard ratio, 0.49; 95% CI, 0.33‐0.74 [ P= .001]). CONCLUSIONS Patients with neuroendocrine tumors benefit from neoadjuvant chemotherapy, as evidenced by better overall survival and lower rates of non‐organ‐confined disease at the time of RC. For tumors with micropapillary differentiation, sarcomatoid differentiation, or adenocarcinoma, neoadjuvant chemotherapy decreased the frequency of non‐organ‐confined disease at the time of RC. However, this favorable effect did not translate into a statistically significant overall survival benefit for these patients, potentially due to the aggressive tumor biology. Cancer 2017;123:4346‐55 . © 2017 American Cancer Society .