Long-Term Outcomes in Patients with Localized Plasmacytoid Bladder Cancer

The plasmacytoid variant of bladder cancer (PV-BCa) is an aggressive subtype with a low 5-year survival rate. Mutations that lead to truncation of CDH1 are central to the pathology of PV-BCa and lead to loss of E-cadherin expression, which in turn allows the invasive spread of tumor cells. To provide a better understanding of the clinical outcomes of this variant, Sood et al. characterized recurrence, survival, and response to different treatments over a twenty-year period at the MD Anderson Cancer Center.

The investigators conducted a retrospective chart review on 56 eligible patients. Among these, 85.7% were men and 87.5% were Caucasian. The median age at diagnosis was 65 years. The majority of patients (75%) underwent planned radical cystectomy with lymph node dissection and received chemotherapy in the neoadjuvant/induction, adjuvant, or perioperative setting (87.5%). Only 7.2% of patients achieved pT0 stage while 52.4% of patients had pN+ disease at surgery. Following neoadjuvant chemotherapy (NAC) or induction chemotherapy, 31.1% of patients exhibited pathological T-stage downstaging. The median duration of stay after surgery was seven days, with 64.3% of patients exhibiting complications within a 90-day period. The median follow-up time was 43.7 months. At 36 months, 28.4% (95% CI, 22.1 – 34.5) of patients were alive and 22.2% (95% CI, 16.1 – 28.5) did not have metastatic disease. In patients with localized disease, NAC was not associated with improved metastasis-free survival (MFS, p = 0.61) or cancer-specific survival (CSS, p = 0.54). However, radical cystectomy was associated with improved MFS and CSS among patients with localized or locally advanced disease (p < 0.001). During the follow-up period, 75% of patients developed recurrence or metastasis and/or died. The median time to metastasis from the end of primary treatment was 6.5 months, whereby metastasis most frequently occurred in peritoneum/carcinomatosis (45.2%) followed by bowel (26.2%), bone (26.2%), lymph nodes (21.4%), and liver (11.9%). Seven patients (16.7%) received immunotherapy after failing chemotherapy, while 19 patients (45.2%) received chemotherapy alone. Salvage therapy was associated with significantly improved CSS in patients with metastatic disease (p < 0.001).

This study highlights the aggressive nature of this condition with the majority of patients developing intra-peritoneal metastasis soon after therapy. More effective and integrated therapeutic strategies deployed early in the course of the disease will be critical.

Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine

References:

Sood A, Rudzinski JK, Labbate CV, et al. Long-Term Oncological Outcomes in Patients Diagnosed With Nonmetastatic Plasmacytoid Variant of Bladder Cancer: A 20-Year University of Texas MD Anderson Cancer Center Experience. J Urol. 2024;211(2):241-255. doi:10.1097/JU.0000000000003778

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