Micropapillary bladder cancer: Stage at presentation and treatment outcome—Analysis of 121 patients from a cancer database.

Abstract

289 Background: The micropapillary variant of transitional cell cancer(MPTCC) is an aggressive pathological subtype of bladder cancer and radical cystectomy is recommended for patients with non−muscle invasive disease. This study compares the treatment patterns and survival outcome in 121 patients. Methods: Patients with MPTCC (code 8131) were identified from the Surveillance Epidemiology and End Results (SEER 17) database. Data was analyzed for demographics, stage, treatment, overall (OS) and cancer specific survival (CSS). Appropriate statistical tests were used. Results: 121 patients were identified (2001−08). Mean age was 73.3 years, 76.9% were male (76.9%, n=93), 82.7% were Caucasian. 40.5% (n=49) had non−muscle invasive (NMI) disease and 59.5% had muscle−invasive disease (MI) at diagnosis. The T stage was Ta or Tis (n=17), T1 (n=32), T2 (n=38) T3 (n=20) and T4 (n=14). 23 patients had node positive disease, the nodal status was not known in 4 patients. 10 patients had distant metastasis. Surgical procedures performed include, TURBT (n=83), Radical cystectomy (n=34), pelvic exenteration (n=1) and partial cystectomy (n=3). 8 patients received post−operative radiotherapy. The mean OS was 64.9, 42.9, 16.1 and 50.2 months and the mean CSS was 81.2, 56.3, 15.7 and 64.4 months for NMI, MI, distant and the whole group respectively. The 5−year OS was 40%, 54% and 34% and the 5 year CSS was 62%, 53% and 82% for the whole group, MI and NMI respectively. All patients with distant disease were dead by 28 months. On analysis of CSS by treatment type the 5−yr CSS for NMI was 81% (n=36) after TURBT and 100% (n=3) after Radical surgery. For MI disease the 3−yr CSS was 66% after TURBT (n=18) and the 5−yr CSS was 54% after radical surgery (n=29). On multivariate analysis, higher stage and age were associated with worse survival. TURBT was associated with better survival. Conclusions: MPTCC is a rare variant of TCC. 81% survival can be achieved with TURBT for non-muscle invasive MPTCC.