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., Piccinelli, M., Tian, Z., Parodi, S., Montorsi, F., Chun, F. K. H. ., Graefen, M., Antonelli, A., Saad, F., Shariat, S. F., De Cobelli, O., Suardi, N. R., Borghesi, M., Terrone, 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

Section

Original Research