Unfavorable Cancer-specific Survival After Neoadjuvant Chemotherapy and Radical Cystectomy in Patients With Bladder Cancer and Squamous Cell Variant: A Multi-institutional Study

Overview

Journal Clin Genitourin Cancer

Publisher Elsevier

Specialties Oncology
Urology

Date 2020 Mar 8

PMID 32144050

Citations 8

Authors

Marco Bandini

Filippo Pederzoli

Russell Madison

Alberto Briganti

Jeffrey S Ross

Gunter Niegisch

Evan Y Yu

Aristotelis Bamias

Neeraj Agarwal

Srikala S Sridhar

Jonathan E Rosenberg

Joaquim Bellmunt

Sumanta Kumar Pal

Matthew D Galsky

Roberta Luciano

Andrea Gallina

Andrea Salonia

Francesco Montorsi

Siraj M Ali

Jon H Chung

Andrea Necchi

Affiliations

Soon will be listed here.

Abstract

Background: Nonurothelial carcinoma (UC) malignancies have traditionally been considered to have a more aggressive clinical course, and little is known about their response to neoadjuvant therapy. We examined the effect of neoadjuvant chemotherapy (NAC) on a large population of patients with bladder cancer (BCa) with different histologic variants (HVs).

Patients And Methods: We relied on a retrospective, multicenter database of 2858 patients with BCa who had undergone radical cystectomy with or without NAC from 1990 to 2017. Pure and mixed HVs were grouped into 6 categories: squamous cell carcinoma (SCC; n = 283; 45%), other subtypes (n = 95; 15%), micropapillary (n = 85; 14%), adenocarcinoma (n = 65; 10%), small cell (n = 54; 8.6%), and sarcomatous (n = 47; 7.6%). Kaplan-Meier and Cox regression analyses were used to examine cancer-specific survival (CSS) according to the HV, using pure UC as the reference. Logistic regression models were used to examine the odds of clinical-to-pathologic downstaging after NAC according to the HV.

Results: Overall, we identified 2229 cases of pure UC and 629 cases of BCa with HVs at radical cystectomy. Of the 450 NAC-treated patients, only those patients with SCC (n = 44; 9.8%) had had worse CSS (median CSS, 33 vs. 116 months; P < .001) and higher mortality rates (hazard ratio, 2.1; P = .03) compared with those with pure UC (n = 328; 72.9%). The results of the analyses were also confirmed when the pure and mixed cases were considered separately. After adjusting for NAC, only SCC showed a lower rate of clinical-to-pathologic downstaging (odds ratio, 0.4; P = .03) compared with UC.

Conclusions: SCC was the HV exhibiting the lowest effect of NAC in terms of activity and CSS. Compared with pure UC, SCC seemed to be insensitive to traditional NAC regimens.

Citing Articles

Squamous Cell Bladder Cancer: A Rare Histological Variant with a Demand for Modern Cancer Therapeutics.

Bell S, Quinn A, Bajo A, Mayberry T, Cowan B, Marrah A Cancers (Basel). 2025; 17(2).

PMID: 39857950 PMC: 11764348. DOI: 10.3390/cancers17020169.

Pesticides and Bladder Cancer: Mechanisms Leading to Anti-Cancer Drug Chemoresistance and New Chemosensitization Strategies.

Lucchesi C, Vasilatis D, Mantrala S, Chandrasekar T, Mudryj M, Ghosh P Int J Mol Sci. 2023; 24(14).

PMID: 37511154 PMC: 10380322. DOI: 10.3390/ijms241411395.

Differences in Cancer-Specific Mortality after Trimodal Therapy for T2N0M0 Bladder Cancer according to Histological Subtype.

Barletta F, Tappero S, Panunzio A, Incesu R, Garcia C, Piccinelli M Cancers (Basel). 2022; 14(23).

PMID: 36497246 PMC: 9736026. DOI: 10.3390/cancers14235766.

Nomogram based on baseline clinicopathological characteristics for predicting bladder cancer-specific survival to neoadjuvant chemotherapy in muscle-invasive bladder cancer.

Font A, Domenech M, Buisan O, Lopez H, Gonzalez A, Etxaniz O World J Urol. 2022; 40(11):2627-2634.

PMID: 36107212 DOI: 10.1007/s00345-022-04147-4.

Molecular Subtypes as a Basis for Stratified Use of Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer-A Narrative Review.

Sjodahl G, Abrahamsson J, Bernardo C, Eriksson P, Hoglund M, Liedberg F Cancers (Basel). 2022; 14(7).

PMID: 35406463 PMC: 8996989. DOI: 10.3390/cancers14071692.

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