Dissecting Patterns of Care in Patients With Variant Histology of Bladder Cancer and Lymph Node Invasion
Objectives: Lymph node invasion (LNI) is related to long-term survival in patients with muscle-invasive bladder cancer. However, in the case of variant histology (VH), data on pelvic lymph node dissection (PLND) and LNI are sparse. We described the pattern of care of PLND in patients with VHs of bla...
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2021-09-01
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| Series: | Société Internationale d’Urologie Journal |
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| Online Access: | https://siuj.org/index.php/siuj/article/view/141/57 |
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| author | Marco Bandini Filippo Pederzoli Andrea Necchi Roger Li Roberta Lucianò Giuseppe Basile Simone Scuderi Riccardo Leni Alberto Briganti Andrea Salonia Francesco Montorsi Andrea Gallina Philippe E. Spiess |
| author_facet | Marco Bandini Filippo Pederzoli Andrea Necchi Roger Li Roberta Lucianò Giuseppe Basile Simone Scuderi Riccardo Leni Alberto Briganti Andrea Salonia Francesco Montorsi Andrea Gallina Philippe E. Spiess |
| author_sort | Marco Bandini |
| collection | DOAJ |
| description | Objectives: Lymph node invasion (LNI) is related to long-term survival in patients with muscle-invasive bladder cancer. However, in the case of variant histology (VH), data on pelvic lymph node dissection (PLND) and LNI are sparse. We described the pattern of care of PLND in patients with VHs of bladder cancer, exploring predictors of LNI.
Methods: Using the 2001–2016 SEER registry, 20 767 bladder cancer patients who underwent PLND were identified. Included histological variants were pure urothelial carcinoma (UC), micropapillary UC, sarcomatoid UC, lymphoepithelioma-like UC, adenocarcinoma, sarcoma, giant and spindle cell carcinoma, squamous cell carcinoma (SCC), and neuroendocrine tumor. Uni- and multivariable logistic regression analyses tested for LNI predictors. Cox regression was used to test for predictors of overall mortality (OM) among both LNI positive and LNI negative patients.
Results: Overall, 2464 (11.9%) harbored a VH. On multivariate analysis, only micropapillary UC was associated with higher risk (OR = 3.39) of LNI. This association was maintained when only the subset of patients treated without perioperative chemotherapy were analyzed (OR = 3.30). Similarly, higher T stage (T2 stage OR = 2.24; T3–4 stage OR = 9.44) and the use of chemotherapy (OR = 2.29) were associated with a higher risk of LNI. Among patients with LNI (5299, 25.5%), SCC (HR = 1.87), T3–4 stage (HR = 1.94), age at diagnosis (HR = 1.01) and geographic region (south) (HR = 1.22) were predictors of higher risk of OM. Conversely, chemotherapy (HR = 0.69) and number of removed LN (HR = −0.99) were associated with lower risk of OM. Finally, in a subgroup of patients without LNI, sarcomatoid UC (HR = 1.58) and giant and spindle cell carcinoma (HR = 1.83) were the only VH predictors of OM.
Conclusions: We described different patterns of care in patients with VHs of bladder cancer. Micropapillary UC was an independent risk factor for LNI. Among patients harboring LNI, those with SCC VH had higher OM compared to pure UC. Conversely, sarcomatoid UC and giant and spindle cell carcinoma were predictors of OM in patients without nodal involvement. |
| format | Article |
| id | doaj-art-b05e067093b34f4eb36518c6d68f0efb |
| institution | OA Journals |
| issn | 2563-6499 |
| language | English |
| publishDate | 2021-09-01 |
| publisher | MDPI AG |
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| series | Société Internationale d’Urologie Journal |
| spelling | doaj-art-b05e067093b34f4eb36518c6d68f0efb2025-08-20T01:59:56ZengMDPI AGSociété Internationale d’Urologie Journal2563-64992021-09-0125282298https://doi.org/10.48083/DHHV3158Dissecting Patterns of Care in Patients With Variant Histology of Bladder Cancer and Lymph Node InvasionMarco Bandini0Filippo Pederzoli1Andrea Necchi2Roger Li3Roberta Lucianò4Giuseppe Basile5Simone Scuderi6Riccardo Leni7Alberto Briganti8Andrea Salonia9Francesco Montorsi10Andrea Gallina11Philippe E. Spiess12Unit of Urology, Urological Research Institute (URI), San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, ItalyUnit of Urology, Urological Research Institute (URI), San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy Unit of Oncology, San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, ItalyMoffitt Cancer Center and Research Institute, Tampa, United States Department of Pathology, IRCCS Ospedale San Raffaele, Milan, Italy Unit of Urology, Urological Research Institute (URI), San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy Unit of Urology, Urological Research Institute (URI), San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy Unit of Urology, Urological Research Institute (URI), San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy Unit of Urology, Urological Research Institute (URI), San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy Unit of Urology, Urological Research Institute (URI), San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy Unit of Urology, Urological Research Institute (URI), San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy Unit of Urology, Urological Research Institute (URI), San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy Moffitt Cancer Center and Research Institute, Tampa, United States Objectives: Lymph node invasion (LNI) is related to long-term survival in patients with muscle-invasive bladder cancer. However, in the case of variant histology (VH), data on pelvic lymph node dissection (PLND) and LNI are sparse. We described the pattern of care of PLND in patients with VHs of bladder cancer, exploring predictors of LNI. Methods: Using the 2001–2016 SEER registry, 20 767 bladder cancer patients who underwent PLND were identified. Included histological variants were pure urothelial carcinoma (UC), micropapillary UC, sarcomatoid UC, lymphoepithelioma-like UC, adenocarcinoma, sarcoma, giant and spindle cell carcinoma, squamous cell carcinoma (SCC), and neuroendocrine tumor. Uni- and multivariable logistic regression analyses tested for LNI predictors. Cox regression was used to test for predictors of overall mortality (OM) among both LNI positive and LNI negative patients. Results: Overall, 2464 (11.9%) harbored a VH. On multivariate analysis, only micropapillary UC was associated with higher risk (OR = 3.39) of LNI. This association was maintained when only the subset of patients treated without perioperative chemotherapy were analyzed (OR = 3.30). Similarly, higher T stage (T2 stage OR = 2.24; T3–4 stage OR = 9.44) and the use of chemotherapy (OR = 2.29) were associated with a higher risk of LNI. Among patients with LNI (5299, 25.5%), SCC (HR = 1.87), T3–4 stage (HR = 1.94), age at diagnosis (HR = 1.01) and geographic region (south) (HR = 1.22) were predictors of higher risk of OM. Conversely, chemotherapy (HR = 0.69) and number of removed LN (HR = −0.99) were associated with lower risk of OM. Finally, in a subgroup of patients without LNI, sarcomatoid UC (HR = 1.58) and giant and spindle cell carcinoma (HR = 1.83) were the only VH predictors of OM. Conclusions: We described different patterns of care in patients with VHs of bladder cancer. Micropapillary UC was an independent risk factor for LNI. Among patients harboring LNI, those with SCC VH had higher OM compared to pure UC. Conversely, sarcomatoid UC and giant and spindle cell carcinoma were predictors of OM in patients without nodal involvement.https://siuj.org/index.php/siuj/article/view/141/57bladder cancerhistological variantslymph node dissectionlymph node metastasis |
| spellingShingle | Marco Bandini Filippo Pederzoli Andrea Necchi Roger Li Roberta Lucianò Giuseppe Basile Simone Scuderi Riccardo Leni Alberto Briganti Andrea Salonia Francesco Montorsi Andrea Gallina Philippe E. Spiess Dissecting Patterns of Care in Patients With Variant Histology of Bladder Cancer and Lymph Node Invasion Société Internationale d’Urologie Journal bladder cancer histological variants lymph node dissection lymph node metastasis |
| title | Dissecting Patterns of Care in Patients With Variant Histology of Bladder Cancer and Lymph Node Invasion |
| title_full | Dissecting Patterns of Care in Patients With Variant Histology of Bladder Cancer and Lymph Node Invasion |
| title_fullStr | Dissecting Patterns of Care in Patients With Variant Histology of Bladder Cancer and Lymph Node Invasion |
| title_full_unstemmed | Dissecting Patterns of Care in Patients With Variant Histology of Bladder Cancer and Lymph Node Invasion |
| title_short | Dissecting Patterns of Care in Patients With Variant Histology of Bladder Cancer and Lymph Node Invasion |
| title_sort | dissecting patterns of care in patients with variant histology of bladder cancer and lymph node invasion |
| topic | bladder cancer histological variants lymph node dissection lymph node metastasis |
| url | https://siuj.org/index.php/siuj/article/view/141/57 |
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