Stefania Zamboni1, Luca Afferi2, Francesco Soria3,4, Atiqullah Aziz5, Mohammad Abufaraj6, Cedric Poyet7, Andrea Necchi8, David D'Andrea9, Giuseppe Simone10, Mariaconsiglia Ferriero10, Ettore Di Trapani11, Claudio Simeone12, Alessandro Antonelli13, Andrea Gallina14, Francesco Montorsi14, Alberto Briganti14, Renzo Colombo14, Giorgio Gandaglia14, Agostino Mattei2, Philipp Baumeister2, Livio Mordasini2, Kees Hendricksen15, Charlotte S Voskuilen15, Michael Rink16, Shahrokh F Shariat4,17,18,19, Evanguelous Xylinas20, Marco Moschini2. 1. Urology Unit, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy. Stefania.zamboni@libero.it. 2. Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland. 3. Division of Urology, Department of Surgical Sciences, University of Studies of Torino, Turin, Italy. 4. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria. 5. Department of Urology, München Klinik Bogenhausen, Munich, Germany. 6. Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan. 7. Department of Urology, University Hospital Zürich, University of Zürich, Zurich, Switzerland. 8. Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 9. Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria. 10. Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy. 11. Department of Urology, European Institute of Oncology, Milan, Italy. 12. Urology Unit, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy. 13. Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. 14. Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, URI, Milan, Italy. 15. Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. 16. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 17. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. 18. Department of Urology, Weill Cornell Medical College, New York, NY, USA. 19. Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia. 20. Department of Urology Bichat Hospital, Paris Descartes University, Paris, France.
Abstract
OBJECTIVES: Adjuvant chemotherapy (ACT) is recommended for non-organ-confined bladder cancer (BCa) after radical cystectomy (RC) and pelvic lymph node dissection (PLND), but there are sparse data regarding its specific efficacy in patients with histological variants. The aim of our study was to evaluate the role of ACT on survival outcomes in patients with variant histology in a large multicenter cohort. MATERIALS AND METHODS: We retrospectively evaluated data of 3963 patients with BCa treated with RC and bilateral PLND with curative intent at several institutions between 1999 and 2018. The histological type was classified into six groups: pure urothelial carcinoma (PUC) or squamous, sarcomatoid, micropapillary, glandular and neuroendocrine differentiation. Multivariable competing risk analysis was applied to assess the role of ACT on recurrence and cancer-specific mortality (CSM) in each histological subtype. RESULTS: Of the 3963 patients included in the study, 23% had variant histology at RC specimen and 723 (18%) patients received ACT. ACT was found to be significantly associated with reduced risk of recurrence (sub-hazard ratio [SHR]: 0.55, confidence interval [CI] 0.42-0.71, p < 0.001) and CSM (SHR: 0.58, CI 0.44-0.78, p < 0.001) in the PUC only, while no histological subtype received a significant benefit on survival outcomes (all p > 0.05) from administration of ACT. The limitation of the study includes the retrospective design, the lack of a central pathology review and the number of ACT cycles. CONCLUSION: In our study, the administration of ACT was associated with improved survival outcomes in PUC only. No histological subtype found a benefit in overall recurrence and CSM from ACT.
OBJECTIVES: Adjuvant chemotherapy (ACT) is recommended for non-organ-confined bladder cancer (BCa) after radical cystectomy (RC) and pelvic lymph node dissection (PLND), but there are sparse data regarding its specific efficacy in patients with histological variants. The aim of our study was to evaluate the role of ACT on survival outcomes in patients with variant histology in a large multicenter cohort. MATERIALS AND METHODS: We retrospectively evaluated data of 3963 patients with BCa treated with RC and bilateral PLND with curative intent at several institutions between 1999 and 2018. The histological type was classified into six groups: pure urothelial carcinoma (PUC) or squamous, sarcomatoid, micropapillary, glandular and neuroendocrine differentiation. Multivariable competing risk analysis was applied to assess the role of ACT on recurrence and cancer-specific mortality (CSM) in each histological subtype. RESULTS: Of the 3963 patients included in the study, 23% had variant histology at RC specimen and 723 (18%) patients received ACT. ACT was found to be significantly associated with reduced risk of recurrence (sub-hazard ratio [SHR]: 0.55, confidence interval [CI] 0.42-0.71, p < 0.001) and CSM (SHR: 0.58, CI 0.44-0.78, p < 0.001) in the PUC only, while no histological subtype received a significant benefit on survival outcomes (all p > 0.05) from administration of ACT. The limitation of the study includes the retrospective design, the lack of a central pathology review and the number of ACT cycles. CONCLUSION: In our study, the administration of ACT was associated with improved survival outcomes in PUC only. No histological subtype found a benefit in overall recurrence and CSM from ACT.
Authors: Marco Moschini; Shahrokh F Shariat; Roberta Lucianò; David D'Andrea; Beat Foerster; Mohammad Abufaraj; Marco Bandini; Paolo Dell'Oglio; Rocco Damiano; Andrea Salonia; Francesco Montorsi; Alberto Briganti; Renzo Colombo; Andrea Gallina Journal: Clin Genitourin Cancer Date: 2016-12-14 Impact factor: 2.872
Authors: Marco Moschini; Paolo Dell'Oglio; Roberta Luciano'; Giorgio Gandaglia; Francesco Soria; Agostino Mattei; Tobias Klatte; Rocco Damiano; Shahrokh F Shariat; Andrea Salonia; Francesco Montorsi; Alberto Briganti; Renzo Colombo; Andrea Gallina Journal: Urol Oncol Date: 2017-01-10 Impact factor: 3.498
Authors: Sam S Chang; Bernard H Bochner; Roger Chou; Robert Dreicer; Ashish M Kamat; Seth P Lerner; Yair Lotan; Joshua J Meeks; Jeff M Michalski; Todd M Morgan; Diane Z Quale; Jonathan E Rosenberg; Anthony L Zietman; Jeffrey M Holzbeierlein Journal: J Urol Date: 2017-04-26 Impact factor: 7.450
Authors: Shahrokh F Shariat; Robert S Svatek; Derya Tilki; Eila Skinner; Pierre I Karakiewicz; Umberto Capitanio; Patrick J Bastian; Bjoern G Volkmer; Wassim Kassouf; Giacomo Novara; Hans-Martin Fritsche; Jonathan I Izawa; Vincenzo Ficarra; Seth P Lerner; Arthur I Sagalowsky; Mark P Schoenberg; Ashish M Kamat; Colin P Dinney; Yair Lotan; Michael J Marberger; Yves Fradet Journal: BJU Int Date: 2010-02-02 Impact factor: 5.588
Authors: Marco Moschini; David D'Andrea; Stephan Korn; Yasin Irmak; Francesco Soria; Eva Compérat; Shahrokh F Shariat Journal: Nat Rev Urol Date: 2017-09-12 Impact factor: 14.432
Authors: Evanguelos Xylinas; Michael Rink; Brian D Robinson; Yair Lotan; Marek Babjuk; Antonin Brisuda; David A Green; Luis A Kluth; Armin Pycha; Yves Fradet; Talia Faison; Richard K Lee; Pierre I Karakiewicz; Marc Zerbib; Douglas S Scherr; Shahrokh F Shariat Journal: Eur J Cancer Date: 2013-03-04 Impact factor: 9.162
Authors: J Alfred Witjes; Thierry Lebret; Eva M Compérat; Nigel C Cowan; Maria De Santis; Harman Maxim Bruins; Virginia Hernández; Estefania Linares Espinós; James Dunn; Mathieu Rouanne; Yann Neuzillet; Erik Veskimäe; Antoine G van der Heijden; Georgios Gakis; Maria J Ribal Journal: Eur Urol Date: 2016-06-30 Impact factor: 20.096
Authors: Harmke J Groot; Flora E van Leeuwen; Sjoukje Lubberts; Simon Horenblas; Ronald de Wit; J Alfred Witjes; Gerard Groenewegen; Philip M Poortmans; Maarten C C M Hulshof; Otto W M Meijer; Igle J de Jong; Hetty A van den Berg; Tineke J Smilde; Ben G L Vanneste; Maureen J B Aarts; Katarzyna Jóźwiak; Alexandra W van den Belt-Dusebout; Jourik A Gietema; Michael Schaapveld Journal: Cancer Date: 2019-11-15 Impact factor: 6.860