Adjuvant chemotherapy is ineffective in patients with bladder cancer and variant histology treated with radical cystectomy with curative intent.

Adjuvant chemotherapy (ACT) is recommended for non-organ-confined bladder cancer (BCa) after radical cystectomy (RC) and pelvic lymph node dissection (PLND), but there are sparse data regarding its specific efficacy in patients with histological variants. The aim of our study was to evaluate the role of ACT on survival outcomes in patients with variant histology in a large multicenter cohort.

We retrospectively evaluated data of 3963 patients with BCa treated with RC and bilateral PLND with curative intent at several institutions between 1999 and 2018. The histological type was classified into six groups: pure urothelial carcinoma (PUC) or squamous, sarcomatoid, micropapillary, glandular and neuroendocrine differentiation. Multivariable competing risk analysis was applied to assess the role of ACT on recurrence and cancer-specific mortality (CSM) in each histological subtype.

Of the 3963 patients included in the study, 23% had variant histology at RC specimen and 723 (18%) patients received ACT. ACT was found to be significantly associated with reduced risk of recurrence (sub-hazard ratio [SHR]: 0.55, confidence interval [CI] 0.42-0.71, p < 0.001) and CSM (SHR: 0.58, CI 0.44-0.78, p < 0.001) in the PUC only, while no histological subtype received a significant benefit on survival outcomes (all p > 0.05) from administration of ACT. The limitation of the study includes the retrospective design, the lack of a central pathology review and the number of ACT cycles.

In our study, the administration of ACT was associated with improved survival outcomes in PUC only. No histological subtype found a benefit in overall recurrence and CSM from ACT.

World journal of urology. 2020 Jul 25 [Epub ahead of print]

Stefania Zamboni, Luca Afferi, Francesco Soria, Atiqullah Aziz, Mohammad Abufaraj, Cedric Poyet, Andrea Necchi, David D'Andrea, Giuseppe Simone, Mariaconsiglia Ferriero, Ettore Di Trapani, Claudio Simeone, Alessandro Antonelli, Andrea Gallina, Francesco Montorsi, Alberto Briganti, Renzo Colombo, Giorgio Gandaglia, Agostino Mattei, Philipp Baumeister, Livio Mordasini, Kees Hendricksen, Charlotte S Voskuilen, Michael Rink, Shahrokh F Shariat, Evanguelous Xylinas, Marco Moschini

Urology Unit, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy. ., Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland., Division of Urology, Department of Surgical Sciences, University of Studies of Torino, Turin, Italy., Department of Urology, München Klinik Bogenhausen, Munich, Germany., Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan., Department of Urology, University Hospital Zürich, University of Zürich, Zurich, Switzerland., Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria., Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy., Department of Urology, European Institute of Oncology, Milan, Italy., Urology Unit, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy., Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy., Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, URI, Milan, Italy., Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria., Department of Urology Bichat Hospital, Paris Descartes University, Paris, France.