Clinical Outcomes of Patients with Histologic Variants of Urothelial Cancer Treated with Trimodality Bladder-sparing Therapy
Abstract Background Trimodality bladder-sparing therapy (TMT) is an acceptable treatment for selected patients with muscle-invasive urothelial cancer. Outcomes of TMT in histologic variants remains largely unknown. Objective To compare outcomes of pure urothelial carcinoma (PUC) to variant urothelia...
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| Veröffentlicht in: | European urology 2017-07, Vol.72 (1), p.54-60 |
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| creator | Krasnow, Ross E Drumm, Michael Roberts, Hannah J Niemierko, Andrzej Wu, Chin-Lee Wu, Shulin Zhang, Jing Heney, Niall M Wszolek, Matthew F Blute, Michael L Feldman, Adam S Lee, Richard J Zietman, Anthony L Shipley, William U Efstathiou, Jason A |
| description | Abstract Background Trimodality bladder-sparing therapy (TMT) is an acceptable treatment for selected patients with muscle-invasive urothelial cancer. Outcomes of TMT in histologic variants remains largely unknown. Objective To compare outcomes of pure urothelial carcinoma (PUC) to variant urothelial carcinoma (VUC) after TMT. Design, setting, and participants Retrospective study of patients treated with TMT at a single cancer center from 1993 until 2013. Outcome measurements and statistical analysis Kaplan-Meier survival probabilities, and univariate and multivariable Cox regression analysis. Results and limitations Of 303 patients treated with TMT, 66 (22%) had VUC. Fifty (76%) had VUC with squamous and/or glandular differentiation and 16 (24%) had other forms. Complete response rate after induction TMT was 83% in PUC and 82% in VUC ( p = 0.9). The 5-yr and 10-yr disease-specific survival (DSS) was 75% and 67% in PUC versus 64% and 64% in VUC. The 5-yr and 10-yr overall survival (OS) was 61% and 42% in PUC versus 52% and 42% in VUC. On multivariable analysis VUC was not associated with DSS (hazard ratio: 1.3, 95% confidence interval: 0.8–2.2, p = 0.3) or OS (hazard ratio: 1.2, 95% confidence interval: 0.8–1.7, p = 0.4). Salvage cystectomy rates were similar (log-rank p = 0.3). Limitations include retrospective design and restriction to variants of urothelial cancer. Conclusions VUC responded to TMT, and there was no significant difference in complete response, OS, DSS, or salvage cystectomy rates compared with PUC. The presence of VUC should not exclude patients from TMT. Patient summary The response of histologic variants of bladder cancer to bladder-sparing chemoradiation is largely unknown. We compared the outcomes of histologic variants of urothelial cancer to pure urothelial cancer in a large series of patients from a single institution. We found that variant histology does not significantly influence outcomes. |
| doi_str_mv | 10.1016/j.eururo.2016.12.002 |
| format | Article |
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Outcomes of TMT in histologic variants remains largely unknown. Objective To compare outcomes of pure urothelial carcinoma (PUC) to variant urothelial carcinoma (VUC) after TMT. Design, setting, and participants Retrospective study of patients treated with TMT at a single cancer center from 1993 until 2013. Outcome measurements and statistical analysis Kaplan-Meier survival probabilities, and univariate and multivariable Cox regression analysis. Results and limitations Of 303 patients treated with TMT, 66 (22%) had VUC. Fifty (76%) had VUC with squamous and/or glandular differentiation and 16 (24%) had other forms. Complete response rate after induction TMT was 83% in PUC and 82% in VUC ( p = 0.9). The 5-yr and 10-yr disease-specific survival (DSS) was 75% and 67% in PUC versus 64% and 64% in VUC. The 5-yr and 10-yr overall survival (OS) was 61% and 42% in PUC versus 52% and 42% in VUC. On multivariable analysis VUC was not associated with DSS (hazard ratio: 1.3, 95% confidence interval: 0.8–2.2, p = 0.3) or OS (hazard ratio: 1.2, 95% confidence interval: 0.8–1.7, p = 0.4). Salvage cystectomy rates were similar (log-rank p = 0.3). Limitations include retrospective design and restriction to variants of urothelial cancer. Conclusions VUC responded to TMT, and there was no significant difference in complete response, OS, DSS, or salvage cystectomy rates compared with PUC. The presence of VUC should not exclude patients from TMT. Patient summary The response of histologic variants of bladder cancer to bladder-sparing chemoradiation is largely unknown. We compared the outcomes of histologic variants of urothelial cancer to pure urothelial cancer in a large series of patients from a single institution. We found that variant histology does not significantly influence outcomes.</description><identifier>ISSN: 0302-2838</identifier><identifier>EISSN: 1873-7560</identifier><identifier>DOI: 10.1016/j.eururo.2016.12.002</identifier><identifier>PMID: 28040351</identifier><language>eng</language><publisher>Switzerland: Elsevier B.V</publisher><subject>Aged ; Bladder cancer ; Boston ; Carcinoma - mortality ; Carcinoma - pathology ; Carcinoma - therapy ; Chemoradiotherapy, Adjuvant - adverse effects ; Chemoradiotherapy, Adjuvant - mortality ; Chemotherapy ; Combined-modality therapy ; Cystectomy ; Cystectomy - adverse effects ; Cystectomy - mortality ; Disease Progression ; Disease-Free Survival ; Female ; Histology ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Invasiveness ; Outcomes ; Proportional Hazards Models ; Radiation therapy ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome ; Trimodality therapy ; Urinary Bladder Neoplasms - mortality ; Urinary Bladder Neoplasms - pathology ; Urinary Bladder Neoplasms - therapy ; Urology ; Urothelium - pathology</subject><ispartof>European urology, 2017-07, Vol.72 (1), p.54-60</ispartof><rights>European Association of Urology</rights><rights>2016 European Association of Urology</rights><rights>Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c417t-53210895913b33f762c82b8bced3766eeed819b3c1ed6467890c032c18a20d993</citedby><cites>FETCH-LOGICAL-c417t-53210895913b33f762c82b8bced3766eeed819b3c1ed6467890c032c18a20d993</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0302283816308995$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28040351$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Krasnow, Ross E</creatorcontrib><creatorcontrib>Drumm, Michael</creatorcontrib><creatorcontrib>Roberts, Hannah J</creatorcontrib><creatorcontrib>Niemierko, Andrzej</creatorcontrib><creatorcontrib>Wu, Chin-Lee</creatorcontrib><creatorcontrib>Wu, Shulin</creatorcontrib><creatorcontrib>Zhang, Jing</creatorcontrib><creatorcontrib>Heney, Niall M</creatorcontrib><creatorcontrib>Wszolek, Matthew F</creatorcontrib><creatorcontrib>Blute, Michael L</creatorcontrib><creatorcontrib>Feldman, Adam S</creatorcontrib><creatorcontrib>Lee, Richard J</creatorcontrib><creatorcontrib>Zietman, Anthony L</creatorcontrib><creatorcontrib>Shipley, William U</creatorcontrib><creatorcontrib>Efstathiou, Jason A</creatorcontrib><title>Clinical Outcomes of Patients with Histologic Variants of Urothelial Cancer Treated with Trimodality Bladder-sparing Therapy</title><title>European urology</title><addtitle>Eur Urol</addtitle><description>Abstract Background Trimodality bladder-sparing therapy (TMT) is an acceptable treatment for selected patients with muscle-invasive urothelial cancer. Outcomes of TMT in histologic variants remains largely unknown. Objective To compare outcomes of pure urothelial carcinoma (PUC) to variant urothelial carcinoma (VUC) after TMT. Design, setting, and participants Retrospective study of patients treated with TMT at a single cancer center from 1993 until 2013. Outcome measurements and statistical analysis Kaplan-Meier survival probabilities, and univariate and multivariable Cox regression analysis. Results and limitations Of 303 patients treated with TMT, 66 (22%) had VUC. Fifty (76%) had VUC with squamous and/or glandular differentiation and 16 (24%) had other forms. Complete response rate after induction TMT was 83% in PUC and 82% in VUC ( p = 0.9). The 5-yr and 10-yr disease-specific survival (DSS) was 75% and 67% in PUC versus 64% and 64% in VUC. The 5-yr and 10-yr overall survival (OS) was 61% and 42% in PUC versus 52% and 42% in VUC. On multivariable analysis VUC was not associated with DSS (hazard ratio: 1.3, 95% confidence interval: 0.8–2.2, p = 0.3) or OS (hazard ratio: 1.2, 95% confidence interval: 0.8–1.7, p = 0.4). Salvage cystectomy rates were similar (log-rank p = 0.3). Limitations include retrospective design and restriction to variants of urothelial cancer. Conclusions VUC responded to TMT, and there was no significant difference in complete response, OS, DSS, or salvage cystectomy rates compared with PUC. The presence of VUC should not exclude patients from TMT. Patient summary The response of histologic variants of bladder cancer to bladder-sparing chemoradiation is largely unknown. We compared the outcomes of histologic variants of urothelial cancer to pure urothelial cancer in a large series of patients from a single institution. We found that variant histology does not significantly influence outcomes.</description><subject>Aged</subject><subject>Bladder cancer</subject><subject>Boston</subject><subject>Carcinoma - mortality</subject><subject>Carcinoma - pathology</subject><subject>Carcinoma - therapy</subject><subject>Chemoradiotherapy, Adjuvant - adverse effects</subject><subject>Chemoradiotherapy, Adjuvant - mortality</subject><subject>Chemotherapy</subject><subject>Combined-modality therapy</subject><subject>Cystectomy</subject><subject>Cystectomy - adverse effects</subject><subject>Cystectomy - mortality</subject><subject>Disease Progression</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Histology</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Neoplasm Invasiveness</subject><subject>Outcomes</subject><subject>Proportional Hazards Models</subject><subject>Radiation therapy</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Trimodality therapy</subject><subject>Urinary Bladder Neoplasms - mortality</subject><subject>Urinary Bladder Neoplasms - pathology</subject><subject>Urinary Bladder Neoplasms - therapy</subject><subject>Urology</subject><subject>Urothelium - pathology</subject><issn>0302-2838</issn><issn>1873-7560</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc2KFDEUhYMoTs_oG4jU0k2VN0n9pDaCNuoMDIxgj9uQSm5Pp01X2iQ10uDDm6JaF25cJSHn3Mv5DiGvKFQUaPt2X-EUpuArll8VZRUAe0JWVHS87JoWnpIVcGAlE1xckMsY9wDAm54_JxdMQJ3vdEV-rZ0drVauuJuS9geMhd8WX1SyOKZY_LRpV1zbmLzzD1YX31Swav7Iovvg0w6dzd61GjWGYhNQJTSLaxPswRvlbDoVH5wyBkMZj9k_PhSbHQZ1PL0gz7bKRXx5Pq_I_aePm_V1eXv3-Wb9_rbUNe1S2XBGQfRNT_nA-bZrmRZsEINGw7u2RUQjaD9wTdG0dduJHjRwpqlQDEzf8yvyZpl7DP7HhDHJg40anVMj-ilKKppaAG1gltaLVAcfY8CtPOYcKpwkBTlzl3u5cJczd0mZzNyz7fV5wzQc0Pw1_QGdBe8WAeacjxaDjDojzhFsQJ2k8fZ_G_4doM_NfccTxr2fwpgZSipjNsivc_dz9bTlmV3f8N--9awM</recordid><startdate>20170701</startdate><enddate>20170701</enddate><creator>Krasnow, Ross E</creator><creator>Drumm, Michael</creator><creator>Roberts, Hannah J</creator><creator>Niemierko, Andrzej</creator><creator>Wu, Chin-Lee</creator><creator>Wu, Shulin</creator><creator>Zhang, Jing</creator><creator>Heney, Niall M</creator><creator>Wszolek, Matthew F</creator><creator>Blute, Michael L</creator><creator>Feldman, Adam S</creator><creator>Lee, Richard J</creator><creator>Zietman, Anthony L</creator><creator>Shipley, William U</creator><creator>Efstathiou, Jason A</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20170701</creationdate><title>Clinical Outcomes of Patients with Histologic Variants of Urothelial Cancer Treated with Trimodality Bladder-sparing Therapy</title><author>Krasnow, Ross E ; Drumm, Michael ; Roberts, Hannah J ; Niemierko, Andrzej ; Wu, Chin-Lee ; Wu, Shulin ; Zhang, Jing ; Heney, Niall M ; Wszolek, Matthew F ; Blute, Michael L ; Feldman, Adam S ; Lee, Richard J ; Zietman, Anthony L ; Shipley, William U ; Efstathiou, Jason A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c417t-53210895913b33f762c82b8bced3766eeed819b3c1ed6467890c032c18a20d993</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Bladder cancer</topic><topic>Boston</topic><topic>Carcinoma - mortality</topic><topic>Carcinoma - pathology</topic><topic>Carcinoma - therapy</topic><topic>Chemoradiotherapy, Adjuvant - adverse effects</topic><topic>Chemoradiotherapy, Adjuvant - mortality</topic><topic>Chemotherapy</topic><topic>Combined-modality therapy</topic><topic>Cystectomy</topic><topic>Cystectomy - adverse effects</topic><topic>Cystectomy - mortality</topic><topic>Disease Progression</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Histology</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Neoplasm Invasiveness</topic><topic>Outcomes</topic><topic>Proportional Hazards Models</topic><topic>Radiation therapy</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Trimodality therapy</topic><topic>Urinary Bladder Neoplasms - mortality</topic><topic>Urinary Bladder Neoplasms - pathology</topic><topic>Urinary Bladder Neoplasms - therapy</topic><topic>Urology</topic><topic>Urothelium - pathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Krasnow, Ross E</creatorcontrib><creatorcontrib>Drumm, Michael</creatorcontrib><creatorcontrib>Roberts, Hannah J</creatorcontrib><creatorcontrib>Niemierko, Andrzej</creatorcontrib><creatorcontrib>Wu, Chin-Lee</creatorcontrib><creatorcontrib>Wu, Shulin</creatorcontrib><creatorcontrib>Zhang, Jing</creatorcontrib><creatorcontrib>Heney, Niall M</creatorcontrib><creatorcontrib>Wszolek, Matthew F</creatorcontrib><creatorcontrib>Blute, Michael L</creatorcontrib><creatorcontrib>Feldman, Adam S</creatorcontrib><creatorcontrib>Lee, Richard J</creatorcontrib><creatorcontrib>Zietman, Anthony L</creatorcontrib><creatorcontrib>Shipley, William U</creatorcontrib><creatorcontrib>Efstathiou, Jason A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European urology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Krasnow, Ross E</au><au>Drumm, Michael</au><au>Roberts, Hannah J</au><au>Niemierko, Andrzej</au><au>Wu, Chin-Lee</au><au>Wu, Shulin</au><au>Zhang, Jing</au><au>Heney, Niall M</au><au>Wszolek, Matthew F</au><au>Blute, Michael L</au><au>Feldman, Adam S</au><au>Lee, Richard J</au><au>Zietman, Anthony L</au><au>Shipley, William U</au><au>Efstathiou, Jason A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical Outcomes of Patients with Histologic Variants of Urothelial Cancer Treated with Trimodality Bladder-sparing Therapy</atitle><jtitle>European urology</jtitle><addtitle>Eur Urol</addtitle><date>2017-07-01</date><risdate>2017</risdate><volume>72</volume><issue>1</issue><spage>54</spage><epage>60</epage><pages>54-60</pages><issn>0302-2838</issn><eissn>1873-7560</eissn><abstract>Abstract Background Trimodality bladder-sparing therapy (TMT) is an acceptable treatment for selected patients with muscle-invasive urothelial cancer. Outcomes of TMT in histologic variants remains largely unknown. Objective To compare outcomes of pure urothelial carcinoma (PUC) to variant urothelial carcinoma (VUC) after TMT. Design, setting, and participants Retrospective study of patients treated with TMT at a single cancer center from 1993 until 2013. Outcome measurements and statistical analysis Kaplan-Meier survival probabilities, and univariate and multivariable Cox regression analysis. Results and limitations Of 303 patients treated with TMT, 66 (22%) had VUC. Fifty (76%) had VUC with squamous and/or glandular differentiation and 16 (24%) had other forms. Complete response rate after induction TMT was 83% in PUC and 82% in VUC ( p = 0.9). The 5-yr and 10-yr disease-specific survival (DSS) was 75% and 67% in PUC versus 64% and 64% in VUC. The 5-yr and 10-yr overall survival (OS) was 61% and 42% in PUC versus 52% and 42% in VUC. On multivariable analysis VUC was not associated with DSS (hazard ratio: 1.3, 95% confidence interval: 0.8–2.2, p = 0.3) or OS (hazard ratio: 1.2, 95% confidence interval: 0.8–1.7, p = 0.4). Salvage cystectomy rates were similar (log-rank p = 0.3). Limitations include retrospective design and restriction to variants of urothelial cancer. Conclusions VUC responded to TMT, and there was no significant difference in complete response, OS, DSS, or salvage cystectomy rates compared with PUC. The presence of VUC should not exclude patients from TMT. Patient summary The response of histologic variants of bladder cancer to bladder-sparing chemoradiation is largely unknown. We compared the outcomes of histologic variants of urothelial cancer to pure urothelial cancer in a large series of patients from a single institution. We found that variant histology does not significantly influence outcomes.</abstract><cop>Switzerland</cop><pub>Elsevier B.V</pub><pmid>28040351</pmid><doi>10.1016/j.eururo.2016.12.002</doi><tpages>7</tpages></addata></record> |
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| subjects | Aged Bladder cancer Boston Carcinoma - mortality Carcinoma - pathology Carcinoma - therapy Chemoradiotherapy, Adjuvant - adverse effects Chemoradiotherapy, Adjuvant - mortality Chemotherapy Combined-modality therapy Cystectomy Cystectomy - adverse effects Cystectomy - mortality Disease Progression Disease-Free Survival Female Histology Humans Kaplan-Meier Estimate Male Middle Aged Multivariate Analysis Neoplasm Invasiveness Outcomes Proportional Hazards Models Radiation therapy Retrospective Studies Risk Factors Time Factors Treatment Outcome Trimodality therapy Urinary Bladder Neoplasms - mortality Urinary Bladder Neoplasms - pathology Urinary Bladder Neoplasms - therapy Urology Urothelium - pathology |
| title | Clinical Outcomes of Patients with Histologic Variants of Urothelial Cancer Treated with Trimodality Bladder-sparing Therapy |
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