Presentation Authors: Juan Javier-DesLoges*, New Haven, CT, Alejandro Abello, Jamil Syed, New Haven , CT, Preston Sprenkle, Michael Hurwitz, New Haven, CT, Patrick Kenney, New Haven , CT, Michael Leapman, New Haven, CT
Introduction: Micropapillary urothelial carcinoma (UC) is associated with aggressive clinical behavior including an increased risk of regional and distant metastasis. Although neoadjuvant chemotherapy (NAC) improves survival for patients with urothelial carcinoma who achieve a complete pathologic response (pT0), less is known regarding the uptake of this practice in patients with micropapillary variant or its effect on pathologic response.
Methods: We queried the National Cancer Database (NCDB) to identify all patients with a diagnosis of UC including mircopapillary variant from 2004-2014. We restricted our analysis to patients who underwent radical cystectomy with or without NAC. We compared clinical, demographic, and pathologic characteristics and evaluated time trends associated with use of NAC. Following propensity score matching to balance covariates associated with the receipt of NAC, we used logistic regression models to study the association of NAC use and pT0 rate. Dual analyses were performed among patients with clinical stage II (cT2) disease, as well as the entire cohort (all stages).
Results: We identified 102,266 patients, including 101,272 (99.03%) pure UC and 994 (0.97%) micropapillary. Patients with micropapillary were younger (Median 70 years vs 73 years, p < 0.001), more commonly male (79.0 vs 73.6% p < 0.001), and were treated more in academic centers (66.43% vs 44.77%). There was no difference between urban/rural areas. From 2004 to 2014, use of NAC among patients with cT2 increased from 27% to 49.7% for UC, and from 50% to 58% for micropapillary. NAC was more common in patients with micropapillary than UC with cT2 disease, 49% vs. 38.4% (P < 0.001). Following propensity score matching, receipt of NAC was associated with pT0 for both histological diagnoses (OR 2.13 95% CI: 1.65-2.78 p < 0.001). This effect persisted on restriction to patients with cT2 (OR 3.32, 95% CI: 2.32-4.75, p < 0.001).
Conclusions: The use of NAC has increased over time. Patients with micropapillary variant are more likely to receive NAC than patients with UC. Patients with cT2 urothelial carcinoma were likely to achieve a pathologic complete response after NAC irrespective of their histology