Mp08-14 Prognostic Significant of Pathologic Response to Preoperative Chemotherapy in Muscle-Invasive Urothelial Carcinoma of the Bladder With Subtype Histology

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation I (MP08)1 May 2024MP08-14 PROGNOSTIC SIGNIFICANT OF PATHOLOGIC RESPONSE TO PREOPERATIVE CHEMOTHERAPY IN MUSCLE-INVASIVE UROTHELIAL CARCINOMA OF THE BLADDER WITH SUBTYPE HISTOLOGY Seth Teplitsky, Will Cranford, Spencer Bell, Joon Kyung Kim, Syndey Strup, Derek Allison, Amanda Saltzman, Zin Myint, Stephen Strup, Akshay Sood, Ashish M. Kamat, Christopher McLouth, and Patrick J. Hensley Seth TeplitskySeth Teplitsky , Will CranfordWill Cranford , Spencer BellSpencer Bell , Joon Kyung KimJoon Kyung Kim , Syndey StrupSyndey Strup , Derek AllisonDerek Allison , Amanda SaltzmanAmanda Saltzman , Zin MyintZin Myint , Stephen StrupStephen Strup , Akshay SoodAkshay Sood , Ashish M. KamatAshish M. Kamat , Christopher McLouthChristopher McLouth , and Patrick J. HensleyPatrick J. Hensley View All Author Informationhttps://doi.org/10.1097/01.JU.0001008780.87855.57.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder cancer with subtype histology (SH) is often treatment refractory, associated with atypical metastases, and has higher cancer-specific mortality than pure urothelial cancers (PUC). Patients with SH are often excluded or underrepresented in preoperative chemotherapy (PC) clinical trials for muscle invasive bladder cancer (MIBC). Additionally, data regarding PC sensitivity for each histologic subtype is conflicting. Herein, we assess prognostic significance of pathologic response to PC in MIBC patients with SH and PUC. METHODS: The National Cancer Database was queried for patients with cT2-4 N0 M0 MIBC who received POC followed by radical cystectomy (RC) between 2018-2020. Patients were stratified into PUC or SH, including squamous, glandular, micropapillary, small cell/neuroendocrine, and sarcomatoid subtypes. Pure squamous and adenocarcinoma were excluded. Pathologic response to PC was codified as complete (ypT0N0), partial (<ypT2N0), and no response (≥ypT2 or N+). Kaplan-Meier analysis and log-rank tests were performed for overall survival (OS) and Cox proportional hazard regressions were performed to test relationships between PC response and the presence of a subtype histology in predicting OS. RESULTS: 5,372 patients were included with 345 (6.4%) having SH. Of the SH patients, 133 (39%) were neuroendocrine/small cell, 79 (23%) micropapillary, 67 (19%) sarcomatoid, 46 (13%) squamous, and 20 (5.8%) glandular. Non-response rates to PC in SH patients were significantly higher than those with PUC (65.2% vs 55.8%, p=0.003). In unstratified analysis, those with SH exhibited shorter OS (p<0.0001). When controlling for pathologic response, patients with SH exhibited shorter OS compared to PUC (p=0.013) with the greatest differences seen in patients achieving partial response to PC (OS HR for PUC 4.88 95% CI 2.29-10.38, p<0.001). CONCLUSIONS: Patients with SH MIBC exhibit poor survival when treated with PC followed by RC compared with PUC, even when controlling for pathologic response. The OS for patients who achieved partial response to POC was similar to patients with PUC who were nonresponders. These data suggest that pathologic response is an inaccurate surrogate endpoint in neoadjuvant trials including both SH and PUC patients. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e120 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Seth Teplitsky More articles by this author Will Cranford More articles by this author Spencer Bell More articles by this author Joon Kyung Kim More articles by this author Syndey Strup More articles by this author Derek Allison More articles by this author Amanda Saltzman More articles by this author Zin Myint More articles by this author Stephen Strup More articles by this author Akshay Sood More articles by this author Ashish M. Kamat More articles by this author Christopher McLouth More articles by this author Patrick J. Hensley More articles by this author Expand All Advertisement PDF downloadLoading ...