Adherence to guideline recommendations for multimodality treatment of patients with pT2-3 M0 non-urothelial carcinoma of the urinary bladder: Temporal trends and survival outcomes.

Abstract

OBJECTIVES:

To analyze contemporary multimodality treatment rates, defined as radical cystectomy plus chemotherapy and/or radiotherapy, for pT2-3 any N-stage M0 non-urothelial carcinoma of urinary bladder patients. Additionally, we tested for the effect of multimodality treatment versus radical cystectomy alone on cancer-specific mortality.

METHODS:

Within the Surveillance, Epidemiology and End Results database (2004-2015), 887 pT2-3 any N-stage M0 non-urothelial carcinoma of urinary bladder patients treated with radical cystectomy were identified. Kaplan-Meier plots, and univariable and multivariable Cox regression analyses focused on cancer-specific mortality rates.

RESULTS:

Squamous cell carcinoma was recorded in 499 (56.3%) patients, neuroendocrine carcinoma in 246 (27.7%) and adenocarcinoma in 142 (16.0%). The highest proportion of multimodality treatment patients was recorded in neuroendocrine carcinoma (69.1%), relative to adenocarcinoma (34.5%) and squamous cell carcinoma (26.4%). A statistically significant annual increase was recorded in multimodality treatment rates in neuroendocrine carcinoma patients (46.7-74.2%, P < 0.01), but not in adenocarcinoma or squamous cell carcinoma patients. The 5-year cancer-specific mortality rate in neuroendocrine carcinoma patients was significantly lower after multimodality treatment versus radical cystectomy alone (37.0% vs 51.5%; P < 0.01), but no statistically significant differences were recorded in both adenocarcinoma (46.1% vs 35.5%; P = 0.8) and squamous cell carcinoma (41.4% vs 31.1%; P = 0.8) patients. In multivariable analyses, for neuroendocrine carcinoma patients, multimodality treatment was an independent predictor of a lower cancer-specific mortality rate (hazard ratio 0.58, P = 0.03).

CONCLUSIONS:

Multimodality treatment has been increasingly used during the study period in neuroendocrine carcinoma patients, and it has translated into a cancer-specific mortality benefit. This is not the case for other non-urothelial carcinoma of urinary bladder patients, such as adenocarcinoma or squamous cell carcinoma.

• Authors: Francesco A Mistretta, Cristina Negrean-Dzyuba, Carlotta Palumbo, Angela Pecoraro, Sophie Knipper, Zhe Tian, Gennaro Musi, Emanuele Montanari, Paul Perrotte, Alberto Briganti, Shahrokh F Shariat, Fred Saad, Ottavio de Cobelli, Pierre I Karakiewicz
• Journal: International journal of urology : official journal of the Japanese Urological Association (Int J Urol) Vol. 27 Issue 5 Pg. 402-407 (May 2020) ISSN: 1442-2042 [Electronic] Australia
• PMID: 32172530 (Publication Type: Journal Article)
• Copyright: © 2020 The Japanese Urological Association.

Topics

• Carcinoma, Transitional Cell (pathology)
• Combined Modality Therapy
• Cystectomy
• Humans
• Kaplan-Meier Estimate
• Neoplasm Staging
• Retrospective Studies
• Urinary Bladder Neoplasms (surgery)