Nicholas H Chakiryan, Da David Jiang, Kyle A Gillis, Elizabeth Green, Ali Hajiran, Lee Hugar, Logan Zemp, Jingsong Zhang, Rohit Jain, Jad Chahoud, Michael Poch, Brandon J Manley, Roger Li, Wade Sexton, Scott M Gilbert,
<h4>Purpose</h4>Patients with muscle invasive bladder cancer (MIBC) of variant histology have a poor prognosis. It is unclear if neoadjuvant chemotherapy prior to radical cystectomy is associated with pathologic downstaging or improved overall survival (OS) for patients with variant histology. Our objective was to assess for associations between receipt of neoadjuvant chemotherapy, pathologic downstaging, and OS for patients with variant histology MIBC.<h4>Methods</h4>Patients were identified in the National Cancer Database from 2004-2017 with MIBC, without metastases, who underwent radical cystectomy. Patients were stratified by histologic subgroup, and receipt or non-receipt of neoadjuvant chemotherapy. Pathologic downstaging was defined as pT0N0 or pT ≤1N0, and OS from the time of diagnosis to date of death or censoring at last follow-up. Multivariable logistic regression analysis determined associations between neoadjuvant chemotherapy and pathologic downstaging. Multivariable Cox regression analysis determined associations between neoadjuvant chemotherapy and OS.<h4>Results</h4>31,218 patients were included in the final study population (Urothelial carcinoma (UC): 27,779; Sarcomatoid UC: 501; Micropapillary UC: 418; Squamous cell carcinoma (SCC): 1,141; Neuroendocrine carcinoma: 629; Adenocarcinoma: 750). Neoadjuvant chemotherapy was associated with pathologic downstaging to pT0N0 in all histologic subgroups (UC: OR 5.1 [4.6-5.6]; Sarcomatoid UC: OR 13.8 [5.5-39.0]; Micropapillary UC: OR 9.7 [2.8-46.8]; SCC: OR 7.4 [2.1-24.5]; Neuroendocrine: OR 4.7 [2.6-9.2]; Adenocarcinoma: OR 23.3 [8.0-74.2]). Neoadjuvant chemotherapy was associated with improved OS for UC (HR 0.8 [0.77-0.84]), sarcomatoid UC (HR 0.64 [0.44-0.91]), and neuroendocrine carcinoma (HR 0.55 [0.43-0.70]).<h4>Conclusions</h4>Neoadjuvant chemotherapy was associated with pathologic downstaging for all MIBC histologic variants, with improved OS for patients with UC, sarcomatoid variant UC, and neuroendocrine carcinoma.
J Urol (The Journal of urology)
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