Radical cystectomy in non-metastatic sarcomatoid bladder cancer: A direct comparison vs urothelial bladder cancer. Issue 1 (January 2023)

• Record Type: Journal Article
• Authors: Tappero, Stefano; Panunzio, Andrea; Hohenhorst, Lukas; Cano Garcia, Cristina; Barletta, Francesco; Piccinelli, Mattia; Tian, Zhe; Parodi, Stefano; Antonelli, Alessandro; Graefen, Markus; Chun, Felix K.H.; Briganti, Alberto; De Cobelli, Ottavio; Saad, Fred; Shariat, Shahrokh F.; Suardi, Nazareno; Borghesi, Marco; Terrone, Carlo; Karakiewicz, Pierre I.
• Is Part Of: European journal of surgical oncology. Volume 49:Issue 1(2023)
• Page Start: 271
• Page End: 277
• Publication Date: 2023-01
• Subjects: Bladder cancer -- Radical cystectomy -- Sarcomatoid; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2022.09.013
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Introduction: The effect of radical cystectomy (RC) on cancer-specific mortality (CSM) is unclear in non-metastatic sarcomatoid bladder cancer (SBC) patients. We aimed to test the benefit of RC in SBC, and to perform a direct comparison vs urothelial bladder cancer (UCB). Materials and methods: Within the Surveillance, Epidemiology, and End Results database (SEER 2001–2018) all non-metastatic SBC and UBC patients were identified. Endpoint of interest was CSM. Propensity score matching (PSM), cumulative incidence plots, competing risks regression (CRR) analyses, three-months landmark analyses, and sensitivity analyses were performed. All results were stratified according to organ-confined (OC: T2 N0 M0 ) vs non-organ-confined (NOC: T3-4 N0 M0 or Tany N1-3 M0 ) stages. Results: Of 554 SBC patients, 49 vs 51% harbored OC vs NOC stages. Of 47, 741 UBC patients, 62 vs 38% harbored OC vs NOC stages. RC rates were 33 vs 67% in OC vs NOC-SBC patients, and 40 vs 60% in OC vs NOC-UBC patients. After 1:1 PSM, comparison between RC vs no-RC was performed in OC-SBC (67 patients per group), OC-UBC (7611 patients per group), NOC-SBC (63 patients per group), and NOC-UBC patients (4644 patients per group). CRR hazard ratios associated with RC vs no-RC were 0.37 (p < 0.001) in OC-SBC vs 0.45 (p < 0.001) in OC-UBC, and 0.56 (p = 0.01) in NOC-SBC vs 0.68 (p < 0.001) in NOC-UBC. These results were replicated in sensitivity and landmark analyses. Conclusions: The protective effect of RC vs no-RC is stronger in SBC than UBC patients, regardless of OC vs NOC stages.