Epaillard Nicolas, Parent Pauline, Loriot Yohann, Lavaud Pernelle, Vera-Cea E-B, Martinez-Chanza Nieves, Rodriguez-Vida Alejo, Dumont Clement, Lozano Rebeca, Llácer Casilda, Ratta Raffaele, Oudard Stephane, Thibault Constance, Auclin Edouard
Medical Oncology Department, Hôpital Européen Georges Pompidou, AP-HP, Université de Paris, Paris, France.
Gustave Roussy, Université Paris-Sud, Université Paris-Saclay, Villejuif, France.
Front Oncol. 2021 May 20;11:671969. doi: 10.3389/fonc.2021.671969. eCollection 2021.
Less than one-third of bladder cancers are non-pure urothelial carcinoma [with variant histological (VH) or non-urothelial carcinoma (non-UC)] for which no treatment guidelines are available. We aim to evaluate the efficacy of systemic treatments in VH or non-UC bladder cancers.
Multicenter retrospective analysis of patients treated for advanced or metastatic VH or non-UC bladder cancers. Primary endpoint was overall response rate (ORR) according to treatment line, regimen and histology subtype. Secondary endpoints were progression-free survival (PFS) and overall survival (OS).
Between 2005 and 2020, 46 patients from seven centers were included. The median age was 66 years (58.75; 74.75), 65.2% were male and 67.2% presented VH. At first line, the ORR for the entire population was 54.4% and median OS was 21.6 months (95% confidence interval [CI]: 14.2-38.6). The ORR of the 37 patients treated with chemotherapy at first line was 62.2% with median PFS and OS of 7.3 (95% CI: 4.5-8.6) and 21.6 months (95% CI: 14.2-35.7), respectively. Dose dense MVAC and platinum doublet chemotherapy had the highest ORR (71.4% and 65.2%). The 9 patients treated with immunotherapy at first line had an ORR of 22.2%, a median PFS of 3.3 months (95% CI:2.3-NR) and the median OS was not reached (95% CI:13.8-NR). Response to treatment varied depending on the histological sub-types and on the treatment type.
Chemotherapy and immunotherapy have shown to be effective in VH or non-UC cancers, a rare histological subtype for which we currently have very little data in the literature.
不到三分之一的膀胱癌是非纯尿路上皮癌[具有组织学变异（VH）或非尿路上皮癌（非UC）]，目前尚无针对此类癌症的治疗指南。我们旨在评估全身治疗对VH或非UC膀胱癌的疗效。
对晚期或转移性VH或非UC膀胱癌患者进行多中心回顾性分析。主要终点是根据治疗线、治疗方案和组织学亚型的总缓解率（ORR）。次要终点是无进展生存期（PFS）和总生存期（OS）。
2005年至2020年期间，纳入了来自七个中心的46例患者。中位年龄为66岁（58.75；74.75），65.2%为男性，67.2%为VH。一线治疗时，总体人群的ORR为54.4%，中位OS为21.6个月（95%置信区间[CI]：14.2 - 38.6）。37例一线接受化疗的患者的ORR为62.2%，中位PFS和OS分别为7.3个月（95% CI：4.5 - 8.6）和21.6个月（95% CI：14.2 - 35.7）。剂量密集型MVAC和铂类双联化疗的ORR最高（分别为71.4%和65.2%）。9例一线接受免疫治疗的患者的ORR为22.2%，中位PFS为3.3个月（95% CI：2.3 - NR），中位OS未达到（95% CI：13.8 - NR）。治疗反应因组织学亚型和治疗类型而异。
化疗和免疫疗法已被证明对VH或非UC癌症有效，这是一种罕见的组织学亚型，目前我们在文献中的数据非常少。
