Clinical Risk Stratification in Patients with Surgically Resectable Micropapillary Bladder Cancer

To analyze survival in clinically localized, surgically resectable micropapillary bladder cancer patients undergoing radical cystectomy with and without neoadjuvant chemotherapy and develop risk strata based on outcome data.

A review of our database identified 103 patients with surgically resectable (≤cT4acN0cM0) micropapillary bladder cancer who underwent radical cystectomy. Survival estimates were calculated using Kaplan-Meier method and compared using log-rank tests. Classification and regression tree analysis was performed to identify risk groups for survival.

For the entire cohort, estimated 5-year overall and disease-specific survival rates were 52% and 58%, respectively. Classification and regression tree analysis identified three risk subgroups: low-risk: cT1, no hydronephrosis; high-risk: ≥cT2, no hydronephrosis; and highest-risk: cTany with tumor-associated hydronephrosis. Five-year disease-specific survival for the low-, high-, and highest-risk groups were 92%, 51%, and 17%, respectively (p<0.001). Patients downstaged at radical cystectomy <pT1 regardless of the use of neoadjuvant chemotherapy had the best survival (5-year disease-specific survival rate, 96% vs. 45% for those not downstaged; p<0.001), while those who were not downstaged despite neoadjuvant chemotherapy had 5-year disease-specific survival of only 17%.

In patients with surgically resectable micropapillary bladder cancer, neoadjuvant chemotherapy appears to confer benefit to patients with muscle-invasive disease without hydronephrosis while patients with cT1 disease present no reason to change standard practice of proceeding to upfront radical cystectomy. Patients with hydronephrosis do poorly regardless of treatment paradigm. However, further external validation studies are needed to support the proposed risk stratification before treatment recommendations can be made This article is protected by copyright. All rights reserved.

BJU international. 2016 Oct 18 [Epub ahead of print]

Mario I Fernández, Stephen B Williams, Daniel L Willis, Rebecca S Slack, Rian J Dickstein, Sahil Parikh, Edmund Chiong, Arlene O Siefker-Radtke, Charles C Guo, Bogdan A Czerniak, David J McConkey, Jay B Shah, Louis L Pisters, H Barton Grossman, Colin P N Dinney, Ashish M Kamat

Departments of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX., Departments of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX., Departments of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center,, Houston, TX., Departments of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX., Departments of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX. .

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