TY - JOUR
TI - Unfavorable Cancer-specific Survival After Neoadjuvant Chemotherapy and Radical Cystectomy in Patients With Bladder Cancer and Squamous Cell Variant: A Multi-institutional Study
AU - Bandini, M.
AU - Pederzoli, F.
AU - Madison, R.
AU - Briganti, A.
AU - Ross, J.S.
AU - Niegisch, G.
AU - Yu, E.Y.
AU - Bamias, A.
AU - Agarwal, N.
AU - Sridhar, S.S.
AU - Rosenberg, J.E.
AU - Bellmunt, J.
AU - Pal, S.K.
AU - Galsky, M.D.
AU - Lucianò, R.
AU - Gallina, A.
AU - Salonia, A.
AU - Montorsi, F.
AU - Ali, S.M.
AU - Chung, J.H.
AU - Necchi, A.
JO - Clinical Genitourinary Cancer
PY - 2020
VL - 18
TODO - 5
SP - e543-e556
PB - HANLEY & BELFUS-ELSEVIER INC
SN - 1558-7673
TODO - 10.1016/j.clgc.2020.01.007
TODO - antineoplastic agent;  carboplatin;  cisplatin;  doxorubicin;  epirubicin;  gemcitabine;  methotrexate;  vinblastine, adjuvant therapy;  adult;  aged;  Article;  bladder cancer;  bladder carcinoma;  bladder papilloma;  bladder sarcoma;  bladder tumor;  cancer patient;  cancer radiotherapy;  cancer specific survival;  cancer staging;  cancer surgery;  controlled study;  cystectomy;  female;  hazard ratio;  histopathology;  human;  Kaplan Meier method;  logistic regression analysis;  lymph node dissection;  major clinical study;  male;  mortality rate;  multicenter study;  multimodality cancer therapy;  neoadjuvant chemotherapy;  odds ratio;  proportional hazards model;  retrospective study;  small cell carcinoma;  squamous cell carcinoma;  transurethral resection;  bladder tumor;  clinical trial;  cystectomy;  epithelium cell;  neoadjuvant therapy;  transitional cell carcinoma, Carcinoma, Transitional Cell;  Cystectomy;  Epithelial Cells;  Humans;  Neoadjuvant Therapy;  Retrospective Studies;  Urinary Bladder Neoplasms
TODO - Background: Nonurothelial carcinoma (UC) malignancies have traditionally been considered to have a more aggressive clinical course, and little is known about their response to neoadjuvant therapy. We examined the effect of neoadjuvant chemotherapy (NAC) on a large population of patients with bladder cancer (BCa) with different histologic variants (HVs). Patients and Methods: We relied on a retrospective, multicenter database of 2858 patients with BCa who had undergone radical cystectomy with or without NAC from 1990 to 2017. Pure and mixed HVs were grouped into 6 categories: squamous cell carcinoma (SCC; n = 283; 45%), other subtypes (n = 95; 15%), micropapillary (n = 85; 14%), adenocarcinoma (n = 65; 10%), small cell (n = 54; 8.6%), and sarcomatous (n = 47; 7.6%). Kaplan-Meier and Cox regression analyses were used to examine cancer-specific survival (CSS) according to the HV, using pure UC as the reference. Logistic regression models were used to examine the odds of clinical-to-pathologic downstaging after NAC according to the HV. Results: Overall, we identified 2229 cases of pure UC and 629 cases of BCa with HVs at radical cystectomy. Of the 450 NAC-treated patients, only those patients with SCC (n = 44; 9.8%) had had worse CSS (median CSS, 33 vs. 116 months; P <.001) and higher mortality rates (hazard ratio, 2.1; P =.03) compared with those with pure UC (n = 328; 72.9%). The results of the analyses were also confirmed when the pure and mixed cases were considered separately. After adjusting for NAC, only SCC showed a lower rate of clinical-to-pathologic downstaging (odds ratio, 0.4; P =.03) compared with UC. Conclusions: SCC was the HV exhibiting the lowest effect of NAC in terms of activity and CSS. Compared with pure UC, SCC seemed to be insensitive to traditional NAC regimens. © 2020 Elsevier Inc.
Little is known about the response to neoadjuvant therapy of nonurothelial carcinoma bladder malignancies. Using a retrospective, multicenter database, we found that squamous cell carcinoma was the histologic type exhibiting the lowest effect of neoadjuvant chemotherapy in terms of activity and cancer-specific survival. Among the nonurothelial carcinoma histologic types, squamous cell carcinoma seems to be insensitive to traditional neoadjuvant chemotherapy regimens. © 2020 Elsevier Inc.
ER -