Introduction

Histological variants of Urothelial carcinoma (UC) of the bladder have a poorer prognosis than histologically pure TCC, and the role of neoadjuvant chemotherapy (NAC) is unclear. Our objective was to evaluate NAC practice patterns and survival outcomes in patients with histologic variants undergoing radical cystectomy (RC) using a large national tumor registry.

Methods

Patients with cT2-4N0-3Mx muscle invasive bladder cancer (MIBC) who underwent RC from 2003-2014 were selected from the National Cancer Database (NCDB). Patients were categorized by histology code as pure UC or histologic variants. Adjusting for patient and clinical characteristics, generalized estimating equations were used to test the association between histology and receipt of NAC. The association between receipt of NAC and overall survival (OS) was evaluated using Kaplan Meier curves and Cox regression models.

Results

In 23,723 patients meeting inclusion criteria, receipt of NAC in histologic variants was less (12-15%) than in pure UC (28%), with the exception of micropapillary disease (29%) [Table 1]. Median OS was lower in variant histologies than for pure UC (11.1 - 29.2 vs. 39.0 months). Receipt of NAC was associated with improved survival compared to RC or RC+adjuvant chemotherapy in patients with pure UC (HR 0.88, p < 0.0001). There was no evidence of a survival benefit for NAC in the variant histologies, or that treatment effects differed by histology (P-val for interaction=0.87).

Conclusions

In the NCDB, a substantial proportion of patients (15%) with histologic variants of MIBC undergoing RC receive NAC in the absence of a proven survival benefit. Clinical trials inclusive of patients with variant histologies are necessary to elucidate the role of NAC prior to RC.

Funding

none