Presentation Authors: Marco Moschini, Stefania Zamboni*, Lucerne, Switzerland, Jeffrey R. Karnes, Rochester, MN, Florian Roghmann, Karl Tully, Herne, Germany, Paul Sargos, Bordeaux, France, Francesco Montorsi, Alberto Briganti, Renzo Colombo, Andrea Gallina, Milan, Italy, Agostino Mattei, Philipp Baumeister, Lucerne, Switzerland, Michael Rink, Hamburg, Germany, Cedric Poyet, Karim Saba, Zürich, Switzerland, Ettore Di Trapani, Ottavio De Cobelli, Gennaro Musi, Milan, Italy, Alessandro Antonelli, Claudio Simeone, Brescia, Italy, Matteo Soligo, Luca Boeri, Rochester, MN, Giuseppe Simone, Michele Gallucci, Rome, Italy, Atiqullah Aziz, Rostock, Germany, Evanguelos Xylinas, Paris, France, Shahrokh F. Shariat, Vienna, Austria
Introduction: Sparse data exists regarding the impact of histological variants on survival outcomes in candidates to radical cystectomy (RC). We benefit from the largest multicenter collaboration available in the literature to evaluate incidence and impact on survival of histological variants at RC.
Methods: We focused on 2,332 patients treated with RC and pelvic lymph node dissection, between 1990 and 2018, at several American and European tertiary referral centers. All specimens were evaluated by dedicated uropatholgists. Univariable and multivariable competing risk regression analyses tested the effect off different histopathological findings on recurrence, cancer specific mortality (CSM) and overall mortality (OM).
Results: Overall, 296 (13%) and 527 (23%) patients were found with histological variants at TUR and RC, respectively. At TUR, considering histological variants, 19 (0.8%) were sarcomatoid, 2 (0.1%) lymphoepitelial, 17 (0.7%) small cell, 107 (4.6%) squamous, 22 (0.9%) micropapillary, 20 (0.9%) neuroendocrine, 7 (0.3%) glandular, 29 (1.2%) adenocarcinoma, 21 (0.9%) mixed and 52 (2.2%) other type of histological variants. At RC, considering histological variants, 63 (2.7%) were sarcomatoid, 1 (0.1%) lymphoepitelial, 19 (0.8%) small cell, 152 (6.5%) squamous, 77 (3.3%) micropapillary, 14 (0.6%) neuroendocrine, 21 (0.9%) glandular, 34 (1.5%) adenocarcinoma, 57 (2.4%) mixed and 89 (3.8%) other type of histological variants. The higher concordance between TUR and RC was find in sarcomatoid (63%) and small cell carcinoma (82%) patients. With a median follow-up of 6.8 years, 831 recurrence, 666 CSM, and 1,039 OM were recorded, respectively. At multivariable Cox regression analyses, the presence of sarcomatoid variant was associated with higher CSM (Hazard Ratio [HR]: 1.57, 95% Confidence Interval [CI]: 1.02-2.41, p=0.04), and OM (HR: 1.53 CI:1.07-2.19, p=0.02) as compared with pure urothelial cancer. Conversely, no survival differences were recorded considering other histological variants (all p> 0.1).
Conclusions: Our multicenter collaboration confirms that histological variant is a frequent finding at TUR and RC. Patients with sarcomatoid variant suffer from the worse survival outcomes when adjusted for all the confounders at the survival analyses.