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Contemporary treatment patterns and outcomes of sarcomatoid bladder cancer

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Abstract

Purpose

To characterize the treatment patterns and survival outcomes of sarcomatoid bladder cancer, a rare urothelial variant histology using a large population level cancer database.

Methods

The National Cancer Database was queried for all cases of sarcomatoid bladder cancer using International Classification of Disease-O-3 morphologic code 8122 between 2004 and 2014. Primary outcome was overall survival.

Results

A total of 489 patients met our inclusion criteria and were included in our analysis. Average age at diagnosis was 70.4 years. The majority of the population was male (61.8%) and Caucasian (92.2%). Tumor characteristics included 23.7% cT1, 41.1% cT2 and 15.3% cT3 or above. Median overall survival was 18.4 months (95% CI 13.3–23.6). On multivariate Cox proportional analysis, radical cystectomy alone or with multimodal therapy (chemotherapy or radiotherapy) resulted in a statistically significant reduction in the risk of death as compared to bladder preservation surgery alone. Survival in the radical cystectomy group did not differ between radical cystectomy alone and those receiving either neoadjuvant or adjuvant chemotherapy.

Conclusions

Sarcomatoid bladder cancer has poor prognosis with 18.4-month median overall survival. While our data suggest that aggressive treatment improves outcomes, the role of multimodal therapy is unclear. Future study should continue to focus on multi-institutional collaboration to determine the most effective therapy.

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Abbreviations

AC:

Adjuvant chemotherapy

BPS:

Bladder preservation surgery

CCI:

Deyo/Charlson Comorbidity Index

MMT:

Multimodal therapy

NAC:

Neoadjuvant chemotherapy

NCDB:

National Cancer Database

PC:

Partial cystectomy

RC:

Radical cystectomy

SaC:

Sarcomatoid carcinoma

SEER:

Surveillance, Epidemiology and End Results

TURBT:

Transurethral resection of bladder tumor

UC:

Urothelial carcinoma

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Authors’ contributions

WS and JTM were involved in project development, data collection, data analysis and manuscript writing; IO, MCT and MBJ analyzed the data, wrote and edited the manuscript; AR was involved in statistical analysis and manuscript writing/editing; SW wrote and edited the manuscript; GJD was involved in protocol/project development, data analysis and manuscript writing.

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Authors and Affiliations

  1. Department of Urology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington, 11th Floor, New York, NY, 10032, USA

    Wilson Sui, Justin T. Matulay, Ifeanyi C. Onyeji, Marissa C. Theofanides, Maxwell B. James, Sven Wenske & G. Joel DeCastro

  2. Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA

    Arindam RoyChoudhury

Authors
  1. Wilson Sui
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  2. Justin T. Matulay
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  3. Ifeanyi C. Onyeji
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  4. Marissa C. Theofanides
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  5. Maxwell B. James
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  6. Arindam RoyChoudhury
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  7. Sven Wenske
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  8. G. Joel DeCastro
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Corresponding author

Correspondence to Wilson Sui.

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Conflict of interest

The authors declare that they have no conflict of interest to disclose.

Ethics approval

The authors affirm that this manuscript has not been submitted to more than one journal for simultaneous consideration nor has it been published separately. The work is entirely our own.

Research involving Human and/or animals rights

This study did not involve any procedures performed on human participants nor did it involve any procedures involving animals. The study was performed in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Availability of data and materials NCDB data may be obtained by application for the participant use file from the American College of Surgeons (https://www.facs.org/quality-programs/cancer/ncdb/puf).

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Sui, W., Matulay, J.T., Onyeji, I.C. et al. Contemporary treatment patterns and outcomes of sarcomatoid bladder cancer. World J Urol 35, 1055–1061 (2017). https://doi.org/10.1007/s00345-016-1962-8

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  • DOI: https://doi.org/10.1007/s00345-016-1962-8

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