Dursun Furkan, Elshabrawy Ahmed, Wang Hanzhang, Wu Shenghui, Liss Michael A, Kaushik Dharam, Grosser Daniel, Svatek Robert S, Mansour Ahmed M
Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX.
Department of Population Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX.
Urol Oncol. 2022 Jun;40(6):275.e1-275.e10. doi: 10.1016/j.urolonc.2022.02.004. Epub 2022 Mar 27.
To compare the overall survival (OS) outcomes of non-muscle invasive bladder cancer (NMIBC) patients with variant histology who underwent radical cystectomy (RC) vs. bladder preservation therapy (BPT).
We investigated the National Cancer Database for NMIBC patients with variant histological features. Patients diagnosed with micropapillary, sarcomatoid, neuroendocrine, squamous, and glandular variants were identified. Inverse probability weighting (IPW)-adjusted Kaplan Meier survival curves and Cox proportional hazard models were utilized to compare OS in the setting of RC versus BPT.
A total of 8,920 (2.7%) NMIBC patients presented with variant histology, of whom 2,450 (27.5%) underwent RC, while 6,470 (72.5%) had BPT. When compared with BPT, patients who underwent RC had significantly higher 5-year OS rates for sarcomatoid (31.9% vs. 23.3%, P < 0.001) neuroendocrine (31% vs. 21.7%, P < 0.001), glandular (44% vs. 41%, P = 0.04) and squamous variants (39.7% vs 19.9%, P < 0.001). This OS benefit was not observed with micropapillary variant (43.9% vs. 53.2% P = 0.14). IPW-adjusted log-rank analysis identified RC as an independent predictor of OS for patients with sarcomatoid (hazards ratio [HR] 0.78, confidence interval [CI] 0.71-0.85, P < 0.001), squamous (HR 0.56, CI 0.53-0.59, P < 0.001), and neuroendocrine variants (HR 0.83, CI 0.76-0.91, P < 0.001), but not for micropapillary variant (HR 1.45, CI 1.24-1.7, P < 0.001).
Among NMIBC patients presenting with variant histologies, RC was associated with better OS for sarcomatoid, squamous, glandular, and neuroendocrine variants when compared to BPT. This OS survival benefit was not observed in patients with micropapillary variant suggesting a potential role for bladder preservation in such population.
比较接受根治性膀胱切除术（RC）与膀胱保留治疗（BPT）的组织学变异型非肌层浸润性膀胱癌（NMIBC）患者的总生存期（OS）结果。
我们在国家癌症数据库中调查了具有组织学变异特征的NMIBC患者。识别出诊断为微乳头状、肉瘤样、神经内分泌、鳞状和腺性变异型的患者。采用逆概率加权（IPW）调整的Kaplan Meier生存曲线和Cox比例风险模型来比较RC与BPT情况下的OS。
共有8920例（2.7%）NMIBC患者表现为组织学变异，其中2450例（27.5%）接受了RC，而6470例（72.5%）接受了BPT。与BPT相比，接受RC的患者肉瘤样变异型（31.9%对23.3%，P<0.001）、神经内分泌变异型（31%对21.7%，P<0.001）、腺性变异型（44%对41%，P=0.04）和鳞状变异型（39.7%对19.9%，P<0.001）的5年OS率显著更高。微乳头状变异型未观察到这种OS获益（43.9%对53.2%，P=0.14）。IPW调整的对数秩分析确定RC是肉瘤样变异型（风险比[HR]0.78，置信区间[CI]0.71-0.85，P<0.001）、鳞状变异型（HR 0.56，CI 0.53-0.59，P<0.001）和神经内分泌变异型（HR 0.83，CI 0.76-0.91，P<0.001）患者OS的独立预测因素，但不是微乳头状变异型患者的独立预测因素（HR 1.45，CI 1.24-1.7 P<0.001）。
在表现为组织学变异的NMIBC患者中;与BPT相比;RC与肉瘤样、鳞状、腺性和神经内分泌变异型更好的OS相关。微乳头状变异型患者未观察到这种OS生存获益;提示膀胱保留在该人群中可能发挥作用。
