Τίτλος:
Unfavorable Cancer-specific Survival After Neoadjuvant Chemotherapy and Radical Cystectomy in Patients With Bladder Cancer and Squamous Cell Variant: A Multi-institutional Study
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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.
Συγγραφείς:
Bandini, M.
Pederzoli, F.
Madison, R.
Briganti, A.
Ross, J.S.
Niegisch, G.
Yu, E.Y.
Bamias, A.
Agarwal, N.
Sridhar, S.S.
Rosenberg, J.E.
Bellmunt, J.
Pal, S.K.
Galsky, M.D.
Lucianò, R.
Gallina, A.
Salonia, A.
Montorsi, F.
Ali, S.M.
Chung, J.H.
Necchi, A.
Περιοδικό:
Clinical Genitourinary Cancer
Εκδότης:
HANLEY & BELFUS-ELSEVIER INC
Λέξεις-κλειδιά:
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
DOI:
10.1016/j.clgc.2020.01.007
