Introduction: Sarcomatoid urothelial carcinoma (SUC) is an unusual variant that bears poor prognosis. Guidelines recommend consideration for early radical cystectomy (RC) in patients with SUC and pT1 tumors. We studied clinicopathologic parameters associated with prognosis for patients receiving neoadjuvant chemotherapy (NAC) Cisplatin+Gemcytobine regimen.
Methods: A retrospective review identified 93 patients who were diagnosed as SUC between 1993 and 2018. H&Es from biopsies/TURB and post NAC RC specimens were reviewed by expert GU pathologists (VP/AM) and tumor size, size of sarcoma component and % of sarcoma were annotated. Log-Rank test, T-test and Spearman correlation were used to assess outcomes.
Results: Median age was 70 yrs; male:female ratio was 3.5:1. Of 93, 27% were 100% sarcomatoid, and 73% were mixed with conventional UC. The mean sizes of total tumor and SUC component were 6cm (SD ± 3.7cm) and 4.5cm (SD ± 3.7cm) respectively. Neither the size of tumor nor percent of the sarcomatoid component correlate with survival (p>0.05). The distribution of SUC by pT stage (pretreatment) was 6%, 31%, 41% and 17% (T1, T2, T3 and T4); 5% were unknown. The average overall survival (OS) was 30 months (range 1-198 months). The OS at 5 years was 10%. The mean OS without RC (n=12) was shorter (8.3 months; p<0.05). The mean SUC tumor size at RC among patients receiving no NAC (n=47) vs NAC (n=20) was 4.6 and 2.8 cm respectively (T-test, p>0.05). There was a significant global difference in OS among patients with different pT stages (pT1-pT4) (Log-Rank Test. P=0.003). There were 6 patients with pT1 tumors with an average age of 68 years and were all males. Four patients had SUC associated with papillary UC, one with flat carcinoma in-situ and one with squamous cell carcinoma. Two pT1 patients received NAC and both had no residual tumor at RC. Four of six patients were alive at an average follow-up of 49 months (1 with metastatic disease, 3 with no evidence of disease), 1 died of disease (patient with small cell carcinoma) and 1 was lost to follow-up.
Conclusions: Our data suggest that the mean OS without RC was significantly shorter compared to patients who underwent RC. Despite the small number of patients with pT1 tumors, they seem to have better survival after cystectomy suggesting that early radical surgery in these patients could be beneficial, and NAC also correlated with better OS. Source of