To assess the role of neoadjuvant chemotherapy (NAC) before robot-assisted radical cystectomy (RARC) for patients with variant histology (VH) muscle-invasive bladder cancer (MIBC).
Retrospective review of 988 patients who underwent RARC (2004-2023) for MIBC. Primary outcomes included the utilization of NAC among this cohort of patients, frequency of downstaging, and discordance between preoperative and final pathology in terms of the presence of VH. Secondary outcomes included disease-specific (DSS), recurrence-free (RFS), and overall survival (OS).
A total of 349 (35%) had VH on transurethral resection or at RARC. The 4 most common VH subgroups were squamous (n = 94), adenocarcinoma (n = 64), micropapillary (n = 34), and sarcomatoid (n = 21). There was no difference in OS (log-rank: P = 0.43 for adenocarcinoma, P = 0.12 for micropapillary, P = 0.55 for sarcomatoid, P = 0.29 for squamous), RFS (log-rank: P = 0.25 for adenocarcinoma, P = 0.35 for micropapillary, P = 0.83 for sarcomatoid, P = 0.79 for squamous), or DSS (log-rank P = 0.91 for adenocarcinoma, P = 0.15 for micropapillary, 0.28 for sarcomatoid, P = 0.92 for squamous) among any of the VH based on receipt of NAC. Patients with squamous histology who received NAC were more likely to be downstaged on final pathology compared to those who did not (P < 0.01).
Our data showed no significant difference in OS, RFS, or DSS for patients with VH MIBC cancer who received NAC before RARC. Patients with the squamous variant who received NAC had more pathologic downstaging compared to those who did not. The role of NAC among patients with VH is yet to be defined. Results were limited by small number in each individual group and lack of exact proportion of VH.
Urologic oncology. 2024 Feb 29 [Epub ahead of print]
Ian Cooke, Nassib Abou Heidar, Abdul Wasay Mahmood, Ali Ahmad, Zhe Jing, Michael Stöckle, Andrew A Wagner, Morgan Roupret, Eric Kim, Nikhil Vasdev, Derya Balbay, Koon Ho Rha, Ahmed Aboumohamed, Prokar Dasgupta, Thomas J Maatman, Lee Richstone, Peter Wiklund, Franco Gaboardi, Qiang Li, Ahmed A Hussein, Khurshid Guru
Roswell Park Comprehensive Cancer Center, Buffalo, NY., Saarland University Medical Center (UKS), Homburg, Germany., Beth Israel Deaconess Medical Center, Boston, MA., Pitie-Salpetriere Hospital, Paris, France., Washington University St. Louis, St. Louis, MO., Lister Hospital (ENHT NHS Trust), Stevenage, United Kingdom., Koç University Hospital, Zeytinburnu/İstanbul, Turkey., Yonsei Medical Health Care System, Sinchon-dong, Seodaemun District, South Korea., Montefiore Medical Center, The Bronx, New York, NY., Guy's Hospital, London, United Kingdom., Metro Health Hospital, Cleveland, OH., Arthur Smith Institute for Urology, Lake Success, NY., Karolinska Institute, Solna, Sweden., Luigi Sacco, Milano, Italy., Roswell Park Comprehensive Cancer Center, Buffalo, NY. Electronic address: .