Response to Neoadjuvant Chemotherapy and Survival in Micropapillary Urothelial Carcinoma: Data From a Tertiary Referral Center and the Surveillance,Epidemiology, and End Results (SEER) Program |
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Authors: | Leonidas N. Diamantopoulos Sarah K. Holt Ali R. Khaki Rishi R. Sekar Adam Gadzinski Yaw A. Nyame Funda Vakar-Lopez Maria S. Tretiakova Sarah P. Psutka John L. Gore Daniel W. Lin George R. Schade Andrew C. Hsieh John K. Lee Todd Yezefski Michael T. Schweizer Heather H. Cheng Evan Y. Yu Jonathan L. Wright |
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Affiliation: | 1. Department of Gynecology and Obstetrics, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, 519000, China;2. Department of Gynecologic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, China;3. Institute of Life Sciences, Chongqing Medical University, Chongqing, 400016, China;1. Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL;2. Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA;3. Department of Urology, University of Washington School of Medicine, Seattle, WA;4. Medical Oncology Division and Palliative Care Division, Department of Internal Medicine, University of Kansas Medical Center, Westwood, KS |
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Abstract: | BackgroundMicropapillary urothelial carcinoma (MPC) is a rare urothelial carcinoma variant with conflicting data guiding clinical practice. In this study, we explored oncologic outcomes in relation to neoadjuvant chemotherapy (NAC) in a retrospective cohort of patients with MPC, alongside data from Surveillance, Epidemiology, and End Results (SEER)-Medicare.Patients and MethodsWe retrospectively identified patients with MPC or conventional urothelial carcinoma (CUC) without any variant histology undergoing radical cystectomy (RC) in our institution (2003-2018). SEER-Medicare was also queried to identify patients diagnosed with MPC (2004-2015). Clinicopathologic data and treatment modalities were extracted. Overall survival (OS) was estimated with the Kaplan-Meier method. Mann-Whitney-Wilcoxon and chi-square tests were used for comparative analysis and Cox regression for identifying clinical covariates associated with OS.ResultsOur institutional database yielded 46 patients with MPC and 457 with CUC. In SEER-Medicare, 183 patients with MPC were identified, and 63 (34%) underwent RC. In the institutional cohort, patients with MPC had significantly higher incidence of cN+ (17% vs. 8%), pN+ stage (30% vs. 17%), carcinoma-in-situ (43% vs. 25%), and lymphovascular invasion (30% vs. 16%) at RC versus those with CUC (all P < .05). Pathologic complete response (ypT0N0) to NAC was 33% for MPC and 35% for CUC (P = .899). Median OS was lower for institutional MPC versus CUC in univariate analysis (43.6 vs. 105.3 months, P = .006); however, MPC was not independently associated with OS in the multivariate model. Median OS was 25 months in the SEER MPC cohort for patients undergoing RC, while NAC was not associated with improved OS in that group.ConclusionPathologic response to NAC was not significantly different between MPC and CUC, while MPC histology was not an independent predictor of OS. Further studies are needed to better understand biological mechanisms behind its aggressive features as well as the role of NAC in this histology variant. |
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Keywords: | Cystectomy Neoadjuvant therapy Pathologic response SEER program Urinary bladder neoplasms |
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