The role of neoadjuvant chemotherapy for patients with variant histology muscle invasive bladder cancer undergoing robotic cystectomy: Data from the International Robotic Cystectomy Consortium

Ian Cooke, Nassib Abou Heidar, Abdul Wasay Mahmood, Ali Ahmad, Zhe Jing, Michael Stokle, Andrew A. Wagner, Morgan Roupret, Eric Kim, Nikhil Vasdev, Mevlana Derya Balbay, Koon Ho Rha, Ahmed Aboumohamed, Prokar Dasgupta, Thomas J. Maatman, Lee Richstone, Peter Wiklund, Franco Gaboardi, Qiang Li, Ahmed A. HusseinKhurshid Guru

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To assess the role of neoadjuvant chemotherapy (NAC) before robot-assisted radical cystectomy (RARC) for patients with variant histology (VH) muscle-invasive bladder cancer (MIBC). Methods: Retrospective review of 988 patients who underwent RARC (2004–2023) for MIBC. Primary outcomes included the utilization of NAC among this cohort of patients, frequency of downstaging, and discordance between preoperative and final pathology in terms of the presence of VH. Secondary outcomes included disease-specific (DSS), recurrence-free (RFS), and overall survival (OS). Results: A total of 349 (35%) had VH on transurethral resection or at RARC. The 4 most common VH subgroups were squamous (n = 94), adenocarcinoma (n = 64), micropapillary (n = 34), and sarcomatoid (n = 21). There was no difference in OS (log-rank: P = 0.43 for adenocarcinoma, P = 0.12 for micropapillary, P = 0.55 for sarcomatoid, P = 0.29 for squamous), RFS (log-rank: P = 0.25 for adenocarcinoma, P = 0.35 for micropapillary, P = 0.83 for sarcomatoid, P = 0.79 for squamous), or DSS (log-rank P = 0.91 for adenocarcinoma, P = 0.15 for micropapillary, 0.28 for sarcomatoid, P = 0.92 for squamous) among any of the VH based on receipt of NAC. Patients with squamous histology who received NAC were more likely to be downstaged on final pathology compared to those who did not (P < 0.01). Conclusion: Our data showed no significant difference in OS, RFS, or DSS for patients with VH MIBC cancer who received NAC before RARC. Patients with the squamous variant who received NAC had more pathologic downstaging compared to those who did not. The role of NAC among patients with VH is yet to be defined. Results were limited by small number in each individual group and lack of exact proportion of VH.

Original languageEnglish
Pages (from-to)117.e17-117.e25
Number of pages9
JournalUrologic Oncology: Seminars and Original Investigations
Volume42
Issue number4
Early online date29 Feb 2024
DOIs
Publication statusPublished - 30 Apr 2024

Keywords

  • Compliance
  • Guidelines
  • Multidisciplinary
  • Prostate Cancer

Fingerprint

Dive into the research topics of 'The role of neoadjuvant chemotherapy for patients with variant histology muscle invasive bladder cancer undergoing robotic cystectomy: Data from the International Robotic Cystectomy Consortium'. Together they form a unique fingerprint.

Cite this