Sarcomatoid Urothelial Carcinoma Is Associated With Limited Response to Neoadjuvant Chemotherapy and Poor Oncologic Outcomes After Radical Cystectomy.

Autor: Sekar RR; Department of Urology, University of Michigan, Ann Arbor, MI. Electronic address: rsekar@med.umich.edu., Diamantopoulos LN; Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA., Bakaloudi DR; Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA., Khaki AR; Division of Oncology, Department of Medicine, Stanford University, Palo Alto, CA., Grivas P; Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA., Winters BR; Department of Urology, Kaiser Permanente Washington, Bellevue, Washington., Vakar-Lopez F; Department of Pathology, University of Washington School of Medicine, Seattle, WA., Tretiakova MS; Department of Pathology, University of Washington School of Medicine, Seattle, WA., Psutka SP; Fred Hutchinson Cancer Center, Seattle, WA; Department of Urology, University of Washington School of Medicine, Seattle, WA., Holt SK; Department of Urology, University of Washington School of Medicine, Seattle, WA., Gore JL; Fred Hutchinson Cancer Center, Seattle, WA; Department of Urology, University of Washington School of Medicine, Seattle, WA., Lin DW; Fred Hutchinson Cancer Center, Seattle, WA; Department of Urology, University of Washington School of Medicine, Seattle, WA., Schade GR; Fred Hutchinson Cancer Center, Seattle, WA; Department of Urology, University of Washington School of Medicine, Seattle, WA., Hsieh AC; Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA., Lee JK; Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA., Yezefski T; Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA., Schweizer MT; Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA., Cheng HH; Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA., Yu EY; Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA., True LD; Department of Pathology, University of Washington School of Medicine, Seattle, WA., Montgomery RB; Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA., Wright JL; Fred Hutchinson Cancer Center, Seattle, WA; Department of Urology, University of Washington School of Medicine, Seattle, WA.
Jazyk: angličtina
Zdroj: Clinical genitourinary cancer [Clin Genitourin Cancer] 2023 Aug; Vol. 21 (4), pp. 507.e1-507.e14. Date of Electronic Publication: 2023 Apr 04.
DOI: 10.1016/j.clgc.2023.03.015
Abstrakt: Introduction: To examine oncologic outcomes and response to neoadjuvant chemotherapy (NAC) in patients with sarcomatoid urothelial carcinoma (SUC) treated with radical cystectomy (RC).
Materials and Methods: We retrospectively queried our institutional database (2003-18) and Surveillance, Epidemiology, and End Results (SEER)-Medicare (2004-2015) for patients with cT2-4, N0-2, M0 SUC and conventional UC (CUC) treated with RC. Clinicopathologic characteristics were described using descriptive statistics (t test, χ2-test and log-rank-test for group comparison). Overall (OS) and recurrence-free-survival (RFS) after RC were estimated with the Kaplan Meier method and associations with OS were evaluated with Cox proportional hazards models.
Results: We identified 38 patients with SUC and 287 patients with CUC in our database, and 190 patients with SUC in SEER-Medicare. In the institutional cohort, patients with SUC versus CUC had higher rates of pT3/4 stage (66% vs. 35%, P < 0.001), lower rates of ypT0N0 (6% vs. 35%, P = .02), and worse median OS (17.5 vs. 120 months, P < .001). Further, patients with SUC in the institutional versus SEER-Medicare cohort had similar median OS (17.5 vs. 21 months). In both cohorts, OS was comparable between patients with SUC undergoing NAC+RC vs. RC alone (17.5 vs. 18.4 months, P = .98, institutional cohort; 24 vs. 20 months, P = .56, SEER cohort). In Cox proportional hazards models for the institutional RC cohort, SUC was independently associated with worse OS (HR 2.3, CI 1.4-3.8, P = .001).
Conclusion: SUC demonstrates poor pathologic response to NAC and worse OS compared with CUC, with no OS benefit associated with NAC. A unique pattern of rapid abdominopelvic cystic recurrence was identified.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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