Adjuvant chemotherapy is ineffective in patients with bladder cancer and variant histology treated with radical cystectomy with curative intent

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 evalu...

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Bibliographic Details
Published in:World journal of urology 2021-06, Vol.39 (6), p.1947-1953
Main Authors: Zamboni, Stefania, Afferi, Luca, Soria, Francesco, Aziz, Atiqullah, Abufaraj, Mohammad, Poyet, Cedric, Necchi, Andrea, D’Andrea, David, Simone, Giuseppe, Ferriero, Mariaconsiglia, Di Trapani, Ettore, Simeone, Claudio, Antonelli, Alessandro, Gallina, Andrea, Montorsi, Francesco, Briganti, Alberto, Colombo, Renzo, Gandaglia, Giorgio, Mattei, Agostino, Baumeister, Philipp, Mordasini, Livio, Hendricksen, Kees, Voskuilen, Charlotte S., Rink, Michael, Shariat, Shahrokh F., Xylinas, Evanguelous, Moschini, Marco
Format: Article
Language:English
Subjects:
Bladder cancer
Chemotherapy
Histology
Lymph nodes
Medicine
Medicine & Public Health
Nephrology
Oncology
Original Article
Survival
Urology
Urothelial carcinoma
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Summary: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  
ISSN:0724-4983
1433-8726
DOI:10.1007/s00345-020-03362-1