Radical cystectomy in non-metastatic sarcomatoid bladder cancer: A direct comparison vs urothelial bladder cancer |
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| Affiliation: | 1. Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany;2. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada;3. Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Rome, Italy;4. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany;5. Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy;6. Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy;7. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria;8. Department of Urology, Weill Cornell Medical College, New York, NY;9. Department of Urology, University of Texas Southwestern, Dallas, TX;10. Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan;11. Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany;12. Department of Urology, Koc University Hospital, Istanbul, Turkey |
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| Abstract: | ![]()
IntroductionThe effect of radical cystectomy (RC) on cancer-specific mortality (CSM) is unclear in non-metastatic sarcomatoid bladder cancer (SBC) patients. We aimed to test the benefit of RC in SBC, and to perform a direct comparison vs urothelial bladder cancer (UCB).Materials and methodsWithin the Surveillance, Epidemiology, and End Results database (SEER 2001–2018) all non-metastatic SBC and UBC patients were identified. Endpoint of interest was CSM. Propensity score matching (PSM), cumulative incidence plots, competing risks regression (CRR) analyses, three-months landmark analyses, and sensitivity analyses were performed. All results were stratified according to organ-confined (OC: T2N0M0) vs non-organ-confined (NOC: T3-4N0M0 or TanyN1-3M0) stages.ResultsOf 554 SBC patients, 49 vs 51% harbored OC vs NOC stages. Of 47,741 UBC patients, 62 vs 38% harbored OC vs NOC stages. RC rates were 33 vs 67% in OC vs NOC-SBC patients, and 40 vs 60% in OC vs NOC-UBC patients. After 1:1 PSM, comparison between RC vs no-RC was performed in OC-SBC (67 patients per group), OC-UBC (7611 patients per group), NOC-SBC (63 patients per group), and NOC-UBC patients (4644 patients per group). CRR hazard ratios associated with RC vs no-RC were 0.37 (p < 0.001) in OC-SBC vs 0.45 (p < 0.001) in OC-UBC, and 0.56 (p = 0.01) in NOC-SBC vs 0.68 (p < 0.001) in NOC-UBC. These results were replicated in sensitivity and landmark analyses.ConclusionsThe protective effect of RC vs no-RC is stronger in SBC than UBC patients, regardless of OC vs NOC stages. |
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| Keywords: | Bladder cancer Radical cystectomy Sarcomatoid |
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