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27.01.2022 | Original Article

Plasmacytoid variant urothelial carcinoma of the bladder: effect of radical cystectomy and chemotherapy in non-metastatic and metastatic patients

verfasst von: Gabriele Sorce, Rocco Simone Flammia, Benedikt Hoeh, Francesco Chierigo, Benedikt Horlemann, Christoph Würnschimmel, Zhe Tian, Markus Graefen, Carlo Terrone, Michele Gallucci, Felix K. H. Chun, Fred Saad, Shahrokh F. Shariat, Francesco Montorsi, Alberto Briganti, Pierre I. Karakiewicz

Erschienen in: World Journal of Urology | Ausgabe 6/2022

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Abstract

Purpose

Data about optimal management of plasmacytoid (PCV) bladder cancer patients are extremely scarce and limited by sample size. We focused on PCV bladder cancer patients to explore the effect of radical cystectomy (RC) and chemotherapy in non-metastatic (T _2–4N_0–3M₀), as well as in metastatic (T_anyN_anyM₁) subgroups.

Methods

Using the Surveillance, Epidemiology and End Results database (2000–2016), we identified 332 PCV patients with muscle-invasive disease or higher (≥ T₂N₀M₀). Kaplan–Meier plots and Cox regression models addressed cancer-specific mortality (CSM).

Results

In 332 PCV patients, median age was 68 years (Interquartile range [IQR]:58–76). Of those, 252 were non-metastatic patients (76%) vs 80 were metastatic patients (24%), at presentation. Of non-metastatic patients, 142 (56%) underwent RC and 131 (52%) underwent chemotherapy. Chemotherapy did not improve CSM in non-metastatic PCV. Conversely, RC was associated with lower CSM (hazard ratio [HR]: 0.51, p = 0.002). Median CSM-free survival was 48 vs 38 months for RC treated vs RC not treated. Of metastatic patients, 22 (28%) underwent RC and 42 (52%) underwent chemotherapy. Both chemotherapy and RC improved CSM in metastatic PCV. Median CSM-free survival was 12 vs 7 months for RC treated vs RC not treated (HR: 0.27, p < 0.001). Median CSM-free survival was 11 vs 4 months for chemotherapy exposed vs chemotherapy naïve (HR: 0.32, p = 0.002).

Conclusions

Although RC resulted in lower CSM, chemotherapy failed to show that effect in non-metastatic PCV patients. Conversely, both chemotherapy and RC resulted in statistically significantly lower CSM in metastatic PCV patients.

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Titel: Plasmacytoid variant urothelial carcinoma of the bladder: effect of radical cystectomy and chemotherapy in non-metastatic and metastatic patients
verfasst von: Gabriele Sorce
Rocco Simone Flammia
Benedikt Hoeh
Francesco Chierigo
Benedikt Horlemann
Christoph Würnschimmel
Zhe Tian
Markus Graefen
Carlo Terrone
Michele Gallucci
Felix K. H. Chun
Fred Saad
Shahrokh F. Shariat
Francesco Montorsi
Alberto Briganti
Pierre I. Karakiewicz
Publikationsdatum: 27.01.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: World Journal of Urology / Ausgabe 6/2022
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-022-03940-5

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Plasmacytoid variant urothelial carcinoma of the bladder: effect of radical cystectomy and chemotherapy in non-metastatic and metastatic patients