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Neoadjuvant chemotherapy for muscle-invasive bladder cancer: does variant histology matter?

  • Urology - Original Paper
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Abstract

Purpose

The most frequent histology of bladder tumors is urothelial carcinoma. Most are pure urothelial carcinomas (PUC) but up to one-third of the cases present variant histological (VH) features. The aim of this study was to evaluate the role of variant histology in neoadjuvant chemotherapy (NAC) response in patients with urothelial muscle-invasive bladder cancer.

Methods

We retrospectively analyzed data from 77 patients with bladder cancer who performed neoadjuvant chemotherapy at two institutions.

Results

Complete pathological response (ypT0) was higher in patients with PUC (38.5%), comparing with VH (12%). Logistic regression analysis demonstrated that variant histology is associated with an 89% lesser likelihood of tumor downstaging, with advanced clinical T stages and positive smoking history as independent predictors. The estimated mean cancer-specific survival was 68.91 months for PUC patients and 50.23 months for VH patients (log rank test, P = 0.024). Multivariate Cox regression analysis demonstrated that VH and clinical T stage were independent predictors of cancer-specific survival, indicating a worse outcome for patients with VH and advanced clinical T stages.

Conclusions

There are only a few retrospective studies evaluating the clinical impact of variant histology tumors, which are mainly managed as PUC. Our results demonstrate that VH is associated with a worse likelihood of tumor downstaging after NAC and a worse cancer-specific survival in bladder cancer patients. There is a need for further studies and genetic analysis to identify the patients most likely to achieve ypT0 status and downstaging after NAC.

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Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

  1. Urology Department, Pedro Hispano Hospital, R. Dr. Eduardo Torres Senhora da Hora, 4464-513, Matosinhos, Portugal

    Raquel Catarino, Diogo Pereira, Gabriel Costa, André Cardoso, Tiago Correia, Manuel Cerqueira, Frederico Carmo Reis & Rui Prisco

  2. Urology Department, Beatriz Angelo Hospital, Loures, Portugal

    Luísa Alves

  3. Urology Department, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal

    João Pereira, Isaac Braga, Rui Freitas, Francisco Lobo, Vítor Silva, Sanches Magalhães & António Morais

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  1. Raquel Catarino
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  4. Gabriel Costa
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Contributions

Conceptualization: RC, LA, and RP; methodology: RC, LA, IB, and RF; data acquisition: DP and JP; analysis: RC, FL, MC, TC, and AC; investigation and data curation: SM, VS, and RP; writing—original draft preparation: RC, GC, and FCR; supervision: AM and RP; all authors read, revised and approved the final version of the manuscript.

Corresponding author

Correspondence to Raquel Catarino.

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Conflict of interests

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

Ethical approval was waived by the local Ethics Committee of Pedro Hispano Hospital in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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Catarino, R., Alves, L., Pereira, D. et al. Neoadjuvant chemotherapy for muscle-invasive bladder cancer: does variant histology matter?. Int Urol Nephrol 54, 3163–3169 (2022). https://doi.org/10.1007/s11255-022-03358-3

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  • DOI: https://doi.org/10.1007/s11255-022-03358-3

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