The effect of chemotherapy in sarcomatoid bladder cancer patients treated with radical cystectomy

Authors

  • Stefano Tappero Cancer Prognostics and Health Outcomes Unit, University of Montréal Hospital Center, Canada
  • Gabriele Sorce Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
  • Benedikt Hoeh Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
  • Lukas Hohenhorst Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
  • Andrea Panunzio Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
  • Cristina Cano Garcia Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
  • Mattia Piccinelli Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
  • Zhe Tian Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
  • Stefano Parodi Department of Urology, IRCCS Policlinico San Martino, Genova, Italy
  • Francesco Montorsi Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
  • Felix K. H. Chun Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
  • Markus Graefen Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
  • Alessandro Antonelli Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona
  • Fred Saad Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
  • Shahrokh F. Shariat Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  • Ottavio De Cobelli Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
  • Nazareno R. Suardi Department of Urology, Spedali Civili of Brescia, Brescia, Italy
  • Marco Borghesi Department of Urology, IRCCS Policlinico San Martino, Genova, Italy
  • Carlo Terrone Department of Urology, IRCCS Policlinico San Martino, Genova, Italy
  • Pierre I. Karakiewicz Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada

DOI:

https://doi.org/10.5489/cuaj.8056

Keywords:

sarcomatoid bladder cancer , chemotherapy , radical cystectomy, SEER

Abstract

INTRODUCTION: Data about the role of chemotherapy in sarcomatoid bladder cancer (SBC) are limited. We addressed the effect of chemotherapy in non-metastatic SBC patients treated with radical cystectomy (RC).

METHODS: Using the Surveillance, Epidemiology, and End Results database (2001–2018), we identified 331 patients with non-metastatic muscle-invasive or higher SBC (T2-4N0-3M0). Kaplan-Meier plots and Cox regression models tested cancer-specific mortality (CSM ). Sample size and power analyses tested for power limitations.

RESULTS: Of 331 SBC patients, 129 (38.9%) were exposed to chemotherapy. The rate of organ-confined stage (T2N0M0) was 33% in both chemotherapy-exposed and chemotherapy-naive patients. In the overall cohort, median CSM -free survival was 84 months (interquartile range [IQR] 21–NA) vs. 26 months (IQR 17–84) in chemotherapy exposed vs. chemotherapy- naive patients, respectively. In multivariable Cox regression models, chemotherapy was associated with lower CSM , without reaching statistical significance (hazard ratio [HR ] 0.72, confidence interval [CI] 0.51–1.01, p=0.054). In subgroup analyses, chemotherapy exposure in organ-confined (n=110) vs. non-organ-confined (n=221) patients resulted in a HR of 0.51 (p=0.12) vs. 0.77 (p=0.17), respectively. Power analyses, based on two-sided a=0.05, revealed values of 52%, 14%, and 43% in the entire population, organ-confined, and nonorgan- confined subgroups, respectively.

CONCLUSIONS: In non-metastatic SBC treated with RC, the association between chemotherapy and lower CSM is particularly strong in organ-confined stage. A substantially larger cohort would be required

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Published

2022-10-25

How to Cite

Tappero, S., Sorce, G., Hoeh, B., Hohenhorst, L., Panunzio, A., Cano Garcia, C., … Karakiewicz, P. I. (2022). The effect of chemotherapy in sarcomatoid bladder cancer patients treated with radical cystectomy. Canadian Urological Association Journal, 17(3), E50–6. https://doi.org/10.5489/cuaj.8056

Issue

Vol. 17 No. 3 (2023): CUAJ March

Section

Original Research

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