Details

Autor(en) / Beteiligte

• Sekar, Rishi R.
• Diamantopoulos, Leonidas N.
• Bakaloudi, Dimitra R.
• Khaki, Ali R.
• Grivas, Petros
• Winters, Brian R.
• Vakar-Lopez, Funda
• Tretiakova, Maria S.
• Psutka, Sarah P.
• Holt, Sarah K.
• Gore, John L.
• Lin, Daniel W.
• Schade, George R.
• Hsieh, Andrew C.
• Lee, John K.
• Yezefski, Todd
• Schweizer, Michael T.
• Cheng, Heather H.
• Yu, Evan Y.
• True, Lawrence D.
• Montgomery, R. Bruce
• Wright, Jonathan L.

Titel

Sarcomatoid Urothelial Carcinoma Is Associated With Limited Response to Neoadjuvant Chemotherapy and Poor Oncologic Outcomes After Radical Cystectomy

Ist Teil von

• Clinical genitourinary cancer, 2023-08, Vol.21 (4), p.507.e1-507.e14

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2023

Quelle

MEDLINE

Beschreibungen/Notizen

• To examine oncologic outcomes and response to neoadjuvant chemotherapy (NAC) in patients with sarcomatoid urothelial carcinoma (SUC) treated with radical cystectomy (RC). We retrospectively queried our institutional database (2003-18) and Surveillance, Epidemiology, and End Results (SEER)-Medicare (2004-2015) for patients with cT2-4, N0-2, M0 SUC and conventional UC (CUC) treated with RC. Clinicopathologic characteristics were described using descriptive statistics (t test, χ2-test and log-rank-test for group comparison). Overall (OS) and recurrence-free-survival (RFS) after RC were estimated with the Kaplan Meier method and associations with OS were evaluated with Cox proportional hazards models. We identified 38 patients with SUC and 287 patients with CUC in our database, and 190 patients with SUC in SEER-Medicare. In the institutional cohort, patients with SUC versus CUC had higher rates of pT3/4 stage (66% vs. 35%, P < 0.001), lower rates of ypT0N0 (6% vs. 35%, P = .02), and worse median OS (17.5 vs. 120 months, P < .001). Further, patients with SUC in the institutional versus SEER-Medicare cohort had similar median OS (17.5 vs. 21 months). In both cohorts, OS was comparable between patients with SUC undergoing NAC+RC vs. RC alone (17.5 vs. 18.4 months, P = .98, institutional cohort; 24 vs. 20 months, P = .56, SEER cohort). In Cox proportional hazards models for the institutional RC cohort, SUC was independently associated with worse OS (HR 2.3, CI 1.4-3.8, P = .001). SUC demonstrates poor pathologic response to NAC and worse OS compared with CUC, with no OS benefit associated with NAC. A unique pattern of rapid abdominopelvic cystic recurrence was identified. Neoadjuvant chemotherapy (NAC) prior to radical cystectomy is associated with improved survival in patients with muscle-invasive conventional urothelial carcinoma (CUC). Sarcomatoid urothelial carcinoma (SUC) is a rare histologic variant associated with aggressive tumor behavior and poor 28 prognosis, however the role of NAC is unclear. In this study, we examined survival outcomes and response to NAC in patients with SUC treated with radical cystectomy.