The effect of chemotherapy in sarcomatoid bladder cancer patients treated with radical cystectomy.

Data about the role of chemotherapy in sarcomatoid bladder cancer (SBC) are limited. We addressed the effect of chemotherapy in non-metastatic SBC patients treated with radical cystectomy.

Using the Surveillance, Epidemiology, and End Results database (2001-2018), we identified 331 patients with non-metastatic muscle-invasive or higher SBC (T2-4N0-3M0). Kaplan-Meier plots and Cox regression models tested cancer-specific mortality (CSM). Sample size and power analyses tested for power limitations.

Of 331 SBC patients, 129 (38.9%) were exposed to chemotherapy. The rate of organ-confined stage (T2N0M0) was 33% in both chemotherapy-exposed and chemotherapy-naive patients. In the overall cohort, median CSM-free survival was 84 months (interquartile range [IQR] 21-NA) vs. 26 months (IQR 17-84) in chemotherapy exposed vs. chemotherapy-naive patients, respectively. In multivariable Cox regression models, chemotherapy was associated with lower CSM, without reaching statistical significance (hazard ratio [HR] 0.72, confidence confined (n=110) vs. non-organ-confined (n=221) patients, resulted in a HR of 0.51 (p=0.12) vs. 0.77 (p=0.17), respectively. Power analyses, based on two-sided α=0.05, revealed values of 52%, 14%, and 43% in the entire population, organ-confined, and non-organ-confined subgroups, respectively.

In non-metastatic SBC treated with RC, the association between chemotherapy and lower CSM is particularly strong in organ-confined stage. A substantially larger cohort would be required to confirm the statistical significance of the recorded protective effect of chemotherapy.

Canadian Urological Association journal = Journal de l'Association des urologues du Canada. 2022 Oct 25 [Epub ahead of print]

Stefano Tappero, Gabriele Sorce, Benedikt Hoeh, Lukas Hohenhorst, Andrea Panunzio, Cristina Cano Garcia, Mattia Piccinelli, Zhe Tian, Stefano Parodi, Francesco Montorsi, Felix K H Chun, Markus Graefen, Alessandro Antonelli, Fred Saad, Shahrokh F Shariat, Ottavio De Cobelli, Nazareno R Suardi, Marco Borghesi, Carlo Terrone, Pierre I Karakiewicz

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Centre, Montreal, QC, Canada., Department of Urology, IRCCS Policlinico San Martino, Genova, Italy., Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy., Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy., Department of Urology, Weill Cornell Medical College, New York, NY, United States., Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy., Department of Urology, Spedali Civili of Brescia, Brescia, Italy.