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• W2941897418 abstract "You have accessJournal of UrologyBladder Cancer: Invasive III (MP38)1 Apr 2019MP38-08 OUTCOMES ASSOCIATED WITH MIXED AND VARIANT HISTOLOGY TREATED WITH CHEMOTHERAPY PRIOR TO CYSTECTOMY AND CYSTECTOMY ALONE Mounsif Azizi*, Charles C. Peyton, Salim K. Cheriyan, William J. Fulp, Richard R. Reich, Samantha Nealon, Matthew Montanarella, Roger Li, Brandon J. Manley, Julio M. Pow-Sang, Michael A. Poch, Philippe E. Spiess, Wade J. Sexton, and Scott M. Gilbert Mounsif Azizi*Mounsif Azizi* More articles by this author , Charles C. PeytonCharles C. Peyton More articles by this author , Salim K. CheriyanSalim K. Cheriyan More articles by this author , William J. FulpWilliam J. Fulp More articles by this author , Richard R. ReichRichard R. Reich More articles by this author , Samantha NealonSamantha Nealon More articles by this author , Matthew MontanarellaMatthew Montanarella More articles by this author , Roger LiRoger Li More articles by this author , Brandon J. ManleyBrandon J. Manley More articles by this author , Julio M. Pow-SangJulio M. Pow-Sang More articles by this author , Michael A. PochMichael A. Poch More articles by this author , Philippe E. SpiessPhilippe E. Spiess More articles by this author , Wade J. SextonWade J. Sexton More articles by this author , and Scott M. GilbertScott M. Gilbert More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556086.23386.faAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Optimal management of mixed and variant histology bladder cancer (BC) is not well defined in part due to lower frequency, tumor heterogeneity and concerns regarding chemo-sensitivity. While neoadjuvant chemotherapy (NAC) is associated with a clear survival benefit for muscle invasive bladder cancer (MIBC) patients with pure urothelial carcinoma (PUC), whether this benefit persists for mixed tumors (MTUC) or variant histology (VHUC) is unclear. We sought to evaluate the effect of NAC on pathological response and survival outcomes in patients with MTUC or VHUC. METHODS: Using a prospective institutional health informatics platform, we identified patients who underwent radical cystectomy (RC) from 2007-2017. Cases were stratified according to histology (PUC, MTUC, VHUC) and receipt of NAC. Outcomes including adjusted logistic and Cox regression models were used to evaluate response to NAC (pathological downstaging) and survival (overall and cancer-specific). RESULTS: Among 768 patients with MIBC, there were 410 (53%) PUC, 185 (24%) MTUC and 173 (23%) VHUC cases. The VHUC group included 76 (44%) micropapillary, 19 (11%) nested, 20 (12%) plasmacytoid, 31 (18%) sarcomatoid and 27 (16%) neuroendocrine cases. The MTUC group consisted of 143 (77%) UC with squamous differentiation and 42 (23%) UC with glandular differentiation patients. 314 (41%) patients with MIBC received NAC prior to RC. There was no difference in NAC receipt between groups. MTUC and VHUC cases were associated with more aggressive disease characteristics (e.g. higher clinical and pathologic stage) (P<0.05). Adjusted logistic regression analysis revealed similar complete downstaging after NAC for MTUC (OR=0.93) and VHUC (OR=1.54) (reference: PUC). On multivariable Cox regression analysis adjusted for age, gender, Elixhauser comorbidity index, clinical stage and NAC receipt, MTUC histology was associated with worse OS (HR=1.44) and CSS (HR=1.40) compared to PUC (P<0.05). Conversely, survival outcomes for patients with VHUC were similar to those with PUC. CONCLUSIONS: VHUC cases in this analysis had similar response rates to NAC and survival compared to PUC. MTUC was associated with poor survival outcomes and inferior response to NAC. Source of Funding: None Tampa, FL© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e536-e537 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mounsif Azizi* More articles by this author Charles C. Peyton More articles by this author Salim K. Cheriyan More articles by this author William J. Fulp More articles by this author Richard R. Reich More articles by this author Samantha Nealon More articles by this author Matthew Montanarella More articles by this author Roger Li More articles by this author Brandon J. Manley More articles by this author Julio M. Pow-Sang More articles by this author Michael A. Poch More articles by this author Philippe E. Spiess More articles by this author Wade J. Sexton More articles by this author Scott M. Gilbert More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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• W2941897418 date "2019-04-01" @default.
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• W2941897418 title "MP38-08 OUTCOMES ASSOCIATED WITH MIXED AND VARIANT HISTOLOGY TREATED WITH CHEMOTHERAPY PRIOR TO CYSTECTOMY AND CYSTECTOMY ALONE" @default.
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