Neoadjuvant chemotherapy prior to radical cystectomy for muscle‐invasive bladder cancer with variant histology

Abstract

Patients with neuroendocrine tumors benefit from neoadjuvant chemotherapy, as evidenced by better overall survival and lower rates of non-organ-confined disease at the time of RC. For tumors with micropapillary differentiation, sarcomatoid differentiation, or adenocarcinoma, neoadjuvant chemotherapy decreased the frequency of non-organ-confined disease at the time of RC. However, this favorable effect did not translate into a statistically significant overall survival benefit for these patients, potentially due to the aggressive tumor biology. Cancer 2017;123:4346-55. © 2017 American Cancer Society.

Impact of adjuvant chemotherapy in patients with adverse features and variant histology at radical cystectomy for muscle‐invasive carcinoma of the bladder: Does histologic subtype matter?

“…In the current report, we examine the effect of AC on overall survival according to histologic subtype using the hospital-based National Cancer Data Base (NCDB). We hypothesized that, in line with our previous findings in the neoadjuvant setting, 12 the benefit of AC would be most pronounced in patients with pure urothelial carcinoma and neuroendocrine tumors but marginal in those with micropapillary differentiated urothelial carcinoma.…”

“…Relying on the American Joint Committee on Cancer staging system, we selected patients with nonmetastatic, localized, muscle‐invasive lymph node‐positive (N+) disease (T2N+M0) and locally advanced disease (≥T3N0/N+M0) who underwent RC, because it is believed that these patients benefit most from AC after RC. We then stratified patients according to the following histologic subtypes: pure urothelial carcinoma, urothelial carcinoma with micropapillary or sarcomatoid differentiation, squamous cell carcinoma, adenocarcinoma, and neuroendocrine tumors …”

“…We then stratified patients according to the following histologic subtypes: pure urothelial carcinoma, urothelial carcinoma with micropapillary or sarcomatoid differentiation, squamous cell carcinoma, adenocarcinoma, and neuroendocrine tumors. 1,12 Patients who received neoadjuvant treatment were excluded. The AC group included patients who received any chemotherapy within 90 days after RC.…”

Variants and new entities of bladder cancer

“…Current literature provides increasingly valuable data on the clinical significance and therapy‐related issues concerning urothelial carcinoma with variant histology compared to conventional urothelial carcinoma. In general, variant urothelial carcinoma is considered an aggressive feature as it worsens overall survival due to a higher rate of upstaging after surgery . Gofrit et al .…”

“…In general, variant urothelial carcinoma is considered an aggressive feature as it worsens overall survival due to a higher rate of upstaging after surgery. [13][14][15][16][17][18][19][20]25,37,38,56,67,[109][110][111][112] Gofrit et al suggest that a patient with variant bladder cancer treated with intravesical immunotherapy has a 27% chance of dying from this disease within 5 years when compared to a 7.5% chance for a patient with conventional high-grade urothelial carcinoma. 20 Cohen et al recommend considering aggressive treatment for bladder cancer with variant histology when identified.…”