Department of Genitourinary Oncology, H Lee Moffitt Cancer Center, Tampa, Florida.
Department of Urology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
J Urol. 2021 Oct;206(4):924-932. doi: 10.1097/JU.0000000000001855. Epub 2021 May 25.
Patients with muscle invasive bladder cancer (MIBC) of variant histology have a poor prognosis. It is unclear if neoadjuvant chemotherapy prior to radical cystectomy is associated with pathological downstaging or improved overall survival (OS) for patients with variant histology. Our objective was to assess for associations between receipt of neoadjuvant chemotherapy, pathological downstaging and OS for patients with variant histology MIBC.
Patients were identified in the National Cancer Database from 2004 to 2017 with MIBC, without metastases, who underwent radical cystectomy. Patients were stratified by histological subgroup, and receipt or nonreceipt of neoadjuvant chemotherapy. Pathological downstaging was defined as pT0N0 or pT ≤1N0, and OS from the time of diagnosis to date of death or censoring at last followup. Multivariable logistic regression analysis determined associations between neoadjuvant chemotherapy and pathological downstaging. Multivariable Cox regression analysis determined associations between neoadjuvant chemotherapy and OS.
A total of 31,218 patients were included in the final study population (urothelial carcinoma [UC]: 27,779; sarcomatoid UC: 501; micropapillary UC: 418; squamous cell carcinoma: 1,141; neuroendocrine carcinoma: 629; adenocarcinoma: 750). Neoadjuvant chemotherapy was associated with pathological downstaging to pT0N0 in all histological subgroups (UC: OR 5.1 [4.6-5.6]; sarcomatoid UC: OR 13.8 [5.5-39.0]; micropapillary UC: OR 9.7 [2.8-46.8]; squamous cell carcinoma: OR 7.4 [2.1-24.5]; neuroendocrine: OR 4.7 [2.6-9.2]; adenocarcinoma: OR 23.3 [8.0-74.2]). Neoadjuvant chemotherapy was associated with improved OS for UC (HR 0.8 [0.77-0.84]), sarcomatoid UC (HR 0.64 [0.44-0.91]) and neuroendocrine carcinoma (HR 0.55 [0.43-0.70]).
Neoadjuvant chemotherapy was associated with pathological downstaging for all MIBC histological variants, with improved OS for patients with UC, sarcomatoid variant UC and neuroendocrine carcinoma.
肌层浸润性膀胱癌（MIBC）的变异型患者预后较差。在根治性膀胱切除术之前接受新辅助化疗是否与变异型 MIBC 患者的病理降期或总体生存（OS）改善相关尚不清楚。我们的目的是评估接受新辅助化疗、病理降期和 OS 与变异型 MIBC 患者之间的关系。
本研究从 2004 年至 2017 年期间，在国家癌症数据库中识别出 MIBC 且无转移的患者，这些患者接受了根治性膀胱切除术。根据组织学亚组和新辅助化疗的接受或不接受情况对患者进行分层。病理降期定义为 pT0N0 或 pT≤1N0，从诊断到死亡或最后一次随访时的截止日期的 OS。多变量逻辑回归分析确定了新辅助化疗与病理降期之间的关联。多变量 Cox 回归分析确定了新辅助化疗与 OS 之间的关联。
共有 31218 例患者纳入最终研究人群（尿路上皮癌 [UC]：27779 例；肉瘤样 UC：501 例；微乳头状 UC：418 例；鳞状细胞癌：1141 例；神经内分泌癌：629 例；腺癌：750 例）。新辅助化疗与所有组织学亚组的病理降期至 pT0N0 相关（UC：比值比 [OR] 5.1 [4.6-5.6]；肉瘤样 UC：OR 13.8 [5.5-39.0]；微乳头状 UC：OR 9.7 [2.8-46.8]；鳞状细胞癌：OR 7.4 [2.1-24.5]；神经内分泌：OR 4.7 [2.6-9.2]；腺癌：OR 23.3 [8.0-74.2]）。新辅助化疗与 UC（HR 0.8 [0.77-0.84]）、肉瘤样 UC（HR 0.64 [0.44-0.91]）和神经内分泌癌（HR 0.55 [0.43-0.70]）的 OS 改善相关。
新辅助化疗与所有 MIBC 组织学变异型的病理降期相关，UC、肉瘤样变异型 UC 和神经内分泌癌患者的 OS 改善。
