Comparative Effectiveness of Treatment Strategies for Squamous Cell Carcinoma of the Bladder

Stensland, Kristian; Zaid, Harras B.; Broadwin, Mark; Sorcini, Andrea; Canes, David; Galsky, Matt D.; Moinzadeh, Alireza

doi:10.1016/j.euo.2018.11.003

Cited by 11 publications

(7 citation statements)

References 17 publications

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“…Two were populations-based studies, while the remaining were based on different center's database. Four studies assessed both NAC and AC in VH, three of which were based on NCDB (9,(31)(32)(33). There were a total of 18 reports comprising 10,192 participants in the NAC studies, 978 (9.6%) of which had received NAC.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

Neoadjuvant and Adjuvant Chemotherapy for Variant Histology Bladder Cancers: A Systematic Review and Meta-Analysis

Zhu

Xiao

et al. 2022

Front. Oncol.

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ContextTo improve the prognosis of variant histology (VH) bladder cancers, clinicians have used neoadjuvant chemotherapy (NAC) or adjuvant chemotherapy (AC) on the basis of radical cystectomy (RC). Despite some new data, the evidence remains mixed on their efficacy.ObjectiveTo update the current evidence on the role of NAC and AC for VH bladder cancers.Evidence AcquisitionWe searched for all studies investigating NAC or AC for bladder cancer patients with variant histology in PubMed, Embase, and the Cochrane Central Register of Controlled Trials up to December 2021. The primary end points were recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS).Evidence SynthesisWe identified 18 reports comprising a total of 10,192 patients in the NAC studies. In patients with VH, the use of NAC did improve CSS (hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.55–0.99, p = 0.044), and OS (HR 0.74, 95% CI 0.66–0.84, p = 0.000), but not RFS (HR 1.15, 95% CI 0.56–2.33, p = 0.706). Subgroup analyses demonstrated that receiving NAC was associated with better OS in sarcomatoid VH (HR 0.67, 95% CI 0.54–0.83, p = 0.000) and neuroendocrine VH (HR 0.54, 95% CI 0.43–0.68, p = 0.000). For AC, we identified eight reports comprising a total of 3254 patients. There was a benefit in CSS (HR 0.61, 95% CI 0.43–0.87, p = 0.006) and OS (HR 0.76, 95% CI 0.60–0.98, p = 0.032). Subgroup analyses demonstrated that only neuroendocrine VH had better CSS (HR 0.29, 95% CI 0.13–0.67, p = 0.174) when receiving AC.ConclusionsNAC or AC for VH bladder cancers confers an OS and CSS benefit compared with RC alone. For NAC, the benefit was independently observed in the sarcomatoid and neuroendocrine subgroups. As for AC, only neuroendocrine subgroups improved CSS.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42021289487.

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Section: Study Selection and Characteristicsmentioning

confidence: 99%

Neoadjuvant and Adjuvant Chemotherapy for Variant Histology Bladder Cancers: A Systematic Review and Meta-Analysis

Zhu

Xiao

et al. 2022

Front. Oncol.

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“…Perioperative chemotherapy was evenly administered in the different histologic subtypes, with patients with lymphoepitheliomalike UC (25, 65.8%), neuroendocrine tumor (250, 65.4%) and micropapillary UC (91, 51.4%) being most frequently treated with chemotherapy. The median number of removed lymph nodes ranged from 11 to 19 in all the study groups (Figure 2): patients with lymphoepithelioma-like UC had the highest number of lymph nodes removed (median 19, interquartile range [IQR]: 7-26), while patients with giant and spindle cell carcinoma had the lowest (11,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19).…”

Section: Overall Descriptive Characteristicsmentioning

confidence: 99%

“…While general agreement exists with respect to pure urothelial carcinoma, fragmentary evidence suggests caution in generalizing these findings to all the other histological variants of urothelial carcinoma and nonurothelial histology [7][8][9][10][11]. Histological variants are present in up to 25% of cystectomy specimens, and they have been traditionally associated with aggressive behavior [12][13][14]. Here, paucity of data about the use and the role of the PLND and the prevalence of lymph node metastases in these histological subtypes makes it difficult to determine a standard of care.…”

Section: Introductionmentioning

confidence: 99%

Dissecting patterns of care in patients with variant histology of bladder cancer and lymph node invasion

Bandini¹,

Pederzoli²,

Necchi³

et al. 2021

Société Internationale D’Urologie Journal

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Objectives Lymph node invasion (LNI) is related to long-term survival in patients with muscle-invasive bladder cancer. However, in the case of variant histology (VH), data on pelvic lymph node dissection (PLND) and LNI are sparse. We described the pattern of care of PLND in patients with VHs of bladder cancer, exploring predictors of LNI. Methods Using the 2001–2016 SEER registry, 20 767 bladder cancer patients who underwent PLND were identified. Included histological variants were pure urothelial carcinoma (UC), micropapillary UC, sarcomatoid UC, lymphoepithelioma-like UC, adenocarcinoma, sarcoma, giant and spindle cell carcinoma, squamous cell carcinoma (SCC), and neuroendocrine tumor. Uni- and multivariable logistic regression analyses tested for LNI predictors. Cox regression was used to test for predictors of overall mortality (OM) among both LNI positive and LNI negative patients. Results Overall, 2464 (11.9%) harbored a VH. On multivariate analysis, only micropapillary UC was associated with higher risk (OR = 3.39) of LNI. This association was maintained when only the subset of patients treated without perioperative chemotherapy were analyzed (OR = 3.30). Similarly, higher T stage (T2 stage OR = 2.24; T3–4 stage OR = 9.44) and the use of chemotherapy (OR = 2.29) were associated with a higher risk of LNI. Among patients with LNI (5299, 25.5%), SCC (HR = 1.87), T3–4 stage (HR = 1.94), age at diagnosis (HR = 1.01) and geographic region (south) (HR = 1.22) were predictors of higher risk of OM. Conversely, chemotherapy (HR = 0.69) and number of removed LN (HR = −0.99) were associated with lower risk of OM. Finally, in a subgroup of patients without LNI, sarcomatoid UC (HR = 1.58) and giant and spindle cell carcinoma (HR = 1.83) were the only VH predictors of OM. Conclusions We described different patterns of care in patients with VHs of bladder cancer. Micropapillary UC was an independent risk factor for LNI. Among patients harboring LNI, those with SCC VH had higher OM compared to pure UC. Conversely, sarcomatoid UC and giant and spindle cell carcinoma were predictors of OM in patients without nodal involvement.

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“…Research is ongoing to identify distinct clinical phenotypes and novel therapeutic targets [186]. On the other hand, urothelial tumors with squamous and glandular differentiation often respond to NAC [187][188][189][190][191][192]. The SWOG S8710 trial evaluating neoadjuvant MVAC included 59 patients with mixed nonurothelial histologies (such as squamous or glandular differentiation) and showed a significant benefit in OS in this cohort [187].…”

Section: Variant Histologymentioning

confidence: 99%

Current Management of Localized Muscle-Invasive Bladder Cancer: A Consensus Guideline from the Genitourinary Medical Oncologists of Canada

Jiang

North

Canil

et al. 2020

BLC

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BACKGROUND: Despite recent advances in the management of muscle-invasive bladder cancer (MIBC), treatment outcomes remain suboptimal, and variability exists across current practice patterns. OBJECTIVE: To promote standardization of care for MIBC in Canada by developing a consensus guidelines using a multidisciplinary, evidence-based, patient-centered approach who specialize in bladder cancer. METHODS: A comprehensive literature search of PubMed, Medline, and Embase was performed; and most recent guidelines from national and international organizations were reviewed. Recommendations were made based on best available evidence, and strength of recommendations were graded based on quality of the evidence. RESULTS: Overall, 17 recommendations were made covering a broad range of topics including pathology review, staging investigations, systemic therapy, local definitive therapy and surveillance. Of these, 10 (59% ) were level 1 or 2, 7 (41% ) were level 3 or 4 recommendations. There were 2 recommendations which did not reach full consensus, and were based on majority opinion. This guideline also provides guidance for the management of cisplatin-ineligible patients, variant histologies, and bladder-sparing trimodality therapy. Potential biomarkers, ongoing clinical trials, and future directions are highlighted. CONCLUSIONS: This guideline embodies the collaborative expertise from all disciplines involved, and provides guidance to further optimize and standardize the management of MIBC.

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Comparative Effectiveness of Treatment Strategies for Squamous Cell Carcinoma of the Bladder

Cited by 11 publications

References 17 publications

Neoadjuvant and Adjuvant Chemotherapy for Variant Histology Bladder Cancers: A Systematic Review and Meta-Analysis

Neoadjuvant and Adjuvant Chemotherapy for Variant Histology Bladder Cancers: A Systematic Review and Meta-Analysis

Dissecting patterns of care in patients with variant histology of bladder cancer and lymph node invasion

Current Management of Localized Muscle-Invasive Bladder Cancer: A Consensus Guideline from the Genitourinary Medical Oncologists of Canada

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