The Impact of Histologic Subtypes on Clinical Outcomes After Radiation-Based Therapy for Muscle-Invasive Bladder Cancer

No AccessJournal of UrologyAdult Urology25 Jul 2024The Impact of Histologic Subtypes on Clinical Outcomes After Radiation-Based Therapy for Muscle-Invasive Bladder Cancer Daniel Halstuch, Ronald Kool, Gautier Marcq, Rodney H. Breau, Peter C. Black, Bobby Shayegan, Michael Kim, Ionut Busca, Hamidreza Abdi, Mark T. Dawidek, Michael Uy, Gagan Fervaha, Fabio L. Cury, Nimira S. Alimohamed, Claudio Jeldres, Ricardo Rendon, Fadi Brimo, D. Robert Siemens, Girish S. Kulkarni, Wassim Kassouf, and Jonathan I. Izawa Daniel HalstuchDaniel Halstuch Division of Urology, Western University, London, Ontario, Canada , Ronald KoolRonald Kool Division of Urology, McGill University Health Center, Montreal, Quebec, Canada Department of Abdominal Surgery, Erasto Gaertner Cancer Center, Curitiba, Brazil , Gautier MarcqGautier Marcq Division of Urology, McGill University Health Center, Montreal, Quebec, Canada , Rodney H. BreauRodney H. Breau Division of Urology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada , Peter C. BlackPeter C. Black Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada , Bobby ShayeganBobby Shayegan Division of Urology, McMaster University, Hamilton, Ontario, Canada , Michael KimMichael Kim Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada , Ionut BuscaIonut Busca Division of Radiation Oncology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada , Hamidreza AbdiHamidreza Abdi Division of Urology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada , Mark T. DawidekMark T. Dawidek Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada , Michael UyMichael Uy Division of Urology, McMaster University, Hamilton, Ontario, Canada , Gagan FervahaGagan Fervaha Department of Urology, Queen's University, Kingston, Ontario, Canada , Fabio L. CuryFabio L. Cury Division of Urology, McGill University Health Center, Montreal, Quebec, Canada Department of Radiation Oncology, McGill University Health Center, Montreal, Quebec, Canada , Nimira S. AlimohamedNimira S. Alimohamed Division of Medical Oncology, University of Calgary, Calgary, Alberta, Canada , Claudio JeldresClaudio Jeldres Division of Urology, University of Sherbrooke, Sherbrooke, Quebec, Canada , Ricardo RendonRicardo Rendon Division of Urology, Dalhousie University, Halifax, Nova Scotia, Canada , Fadi BrimoFadi Brimo Department of Pathology, McGill University Health Center, Montreal, Quebec, Canada , D. Robert SiemensD. Robert Siemens Department of Urology, Queen's University, Kingston, Ontario, Canada , Girish S. KulkarniGirish S. Kulkarni Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada , Wassim KassoufWassim Kassouf Division of Urology, McGill University Health Center, Montreal, Quebec, Canada , and Jonathan I. IzawaJonathan I. Izawa Corresponding Author: Jonathan Izawa, MD, FRCSC, Division of Urology, Department of Surgery, London Health Sciences Centre-Victoria Hospital, 800 Commissioners Rd East, E2-649, London, ON , Canada (email protected) View All Author Informationhttps://doi.org/10.1097/JU.0000000000004160AboutFull TextPDF Cite Export CitationSelect Citation formatNLMAMAIEEEACMAPAChicagoMLAHarvardTips on citation downloadDownload citationCopy citation ToolsAdd to favoritesTrack Citations ShareFacebookLinked InTwitterEmail Abstract Purpose: Outcomes of radiation-based therapy (RT) for muscle-invasive bladder cancer (MIBC) with histologic subtypes of urothelial cancer (HS-UC) are lacking. Our objective was to compare survival outcomes of pure urothelial carcinoma (PUC) to HS-UC after RT. Materials and Methods: A multicenter retrospective study of 864 patients with MIBC who underwent curative-intent RT to the bladder for MIBC (clinical T2-T4aN0-2M0) between 2001 and 2018 was conducted. Regression models were used to test the association between HS-UC and complete response (CR) and survival outcomes after RT. Results: In total, 122 patients (14%) had HS-UC. Seventy-five (61%) had HS-UC with squamous and/or glandular differentiation. A CR was confirmed in 69% of patients with PUC and 63% with HS-UC. There were 207 (28%) and 31 (25%) patients who died of metastatic bladder cancer in the PUC and HS-UC groups, respectively. There were 361 (49%) and 58 (48%) patients who died of any cause in the PUC and HS-UC groups, respectively. Survival outcomes were not statistically different between the groups. The HS-UC status was not associated with survival outcomes in multivariable Cox regression analyses. Conclusions: In our study, HS-UC responded to RT with no significant difference in CR and survival outcomes compared to PUC. The presence of HS-UC in MIBC does not seem to confer resistance to RT, and patients should not be withheld from bladder preservation therapy options. 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Dr Campeau, assistant editor of The Journal of Urology®, was recused from the editorial and peer review processes due to affiliation with McGill University. Dr Lorenzo, assistant editor of The Journal of Urology®, and Dr Wallis, reviewer board member of The Journal of Urology®, were recused from the editorial and peer review processes due to affiliation with the University of Toronto. Funding/Support: None. Conflict of Interest Disclosures: Dr Black reported being a member of an advisory board or equivalent for AbbVie, AstraZeneca, Astellas, Bayer, BMS, EMD-Serono, Ferring, Fergene, Janssen, Merck, miR Scientific, Nonagen, NanOlogy, Prokarium, Protara Therapeutics, QED Bioscience, Roche, Sanofi, Sesen Bio, STIMIT, TerSera, Tolmar, Urogen, Verity; being a member of a speakers bureau for AbbVie, Biosyent, Janssen, Minogue, Ferring, TerSera, Pfizer; receiving grants or honoraria from iProgen; participating in a clinical trial within the past 2 years for Genentech, Janssen, BMS, AstraZeneca, Therelase, Pacific Edge, Pfizer; and sharing a patent with Veracyte. Dr Abdi reported being on the advisory board for TerSera. Dr Alimohamed reported having a consultancy/advisory role for Seagen, BMS, EMD Serono, and Pfizer. Dr Kassouf reported having consultant or advisory roles for Sesen Bio, Ferring, Roche, BMS, Merck, Janssen, Bayer, Astellas, Seagen, Pfizer/EMD Serono, and reported participating in clinical trials for BMS, Roche, Janssen, Theralase, and Pfizer. No other disclosures were reported. Ethics Statement: This study received Institutional Review Board approval. Author Contributions: All authors contributed to interpretation of the data and critically revised the manuscript. Drs Kool and Kassouf provided statistical support. © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited bySiemens D and Routh J Editors' ChoiceJournal of Urology, Supplementary Materials Advertisement Copyright being a member of a speakers bureau for AbbVie, Biosyent, Janssen, Minogue, Ferring, TerSera, Pfizer; receiving grants or honoraria from iProgen; participating in a clinical trial within the past 2 years for Genentech, Janssen, BMS, AstraZeneca, Therelase, Pacific Edge, Pfizer; and sharing a patent with Veracyte. Dr Abdi reported being on the advisory board for TerSera. Dr Alimohamed reported having a consultancy/advisory role for Seagen, BMS, EMD Serono, and Pfizer. Dr Kassouf reported having consultant or advisory roles for Sesen Bio, Ferring, Roche, BMS, Merck, Janssen, Bayer, Astellas, Seagen, Pfizer/EMD Serono, and reported participating in clinical trials for BMS, Roche, Janssen, Theralase, and Pfizer. No other disclosures were reported. Ethics Statement: This study received Institutional Review Board approval. Author Contributions: All authors contributed to interpretation of the data and critically revised the manuscript. Drs Kool and Kassouf provided statistical support. Advertisement PDF downloadLoading ...