Urothelial carcinoma: variant histology does not influence outcomes with trimodality bladder-sparing treatment

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Takeaway
  • No difference in response to induction chemoradiation between pure (PUC) and variant (VUC) urothelial carcinoma. 

Why this matters

  • Largest study to date describing the response of VUC to trimodality bladder-sparing therapy (TMT).

Key results

  • 250 (83%) patients had complete response to induction chemoradiation. 
  • No difference in rates of response between PUC and VUC (83% vs 82%; P=.9). 
  • No patient required radical cystectomy for treatment-related toxicity. 
  • 1-y, 5-y, and 10-y salvage cystectomy rates were 10%, 19%, and 24%, respectively in PUC vs 15%, 28%, and 28%, respectively in VUC (P=.3). 
  • 5-y and 10-y cumulative disease-specific survival (DSS) were 75% and 67% in PUC, vs 64% each in VUC (P=.4). 
  • 5-y and 10-y OS were 61% and 42%, vs 52% and 42% (P=.2). 
  • Bladder-intact DSS was not significantly different between VUC and PUC (P=.3). 
  • In a multivariable model, VUC was not associated with survival. 
  • Age, stage, hydronephrosis, and response to induction chemoradiation were significant predictors of OS. 
  • Hydronephrosis and incomplete response to induction therapy were associated with worse DSS. 

Study design

  • Retrospective study of 303 patients treated with TMT between 1993 and 2013. 
  • Funding: None.

Limitations

  • Single institution experience. 
  • Small sample sizes. 
  • Limited to transurethral resection of the bladder tumor specimens.