1413 PATIENTS WITH MICROPAPILLARY BLADDER CANCER HAVE COMPARABLE STAGE-ADJUSTED SURVIVAL TO PATIENTS WITH UROTHELIAL CARCINOMA FOLLOWING RADICAL CYSTECTOMY: A MATCHED COHORT ANALYSIS (2012)

You have accessJournal of UrologyBladder Cancer: Invasive I1 Apr 20121413 PATIENTS WITH MICROPAPILLARY BLADDER CANCER HAVE COMPARABLE STAGE-ADJUSTED SURVIVAL TO PATIENTS WITH UROTHELIAL CARCINOMA FOLLOWING RADICAL CYSTECTOMY: A MATCHED COHORT ANALYSIS Jeffrey Wang, Stephen Boorjian, John Cheville, Simon Kim, Robert Tarrell, Prabin Thapa, and Igor Frank Jeffrey WangJeffrey Wang Rochester, MN , Stephen BoorjianStephen Boorjian Rochester, MN , John ChevilleJohn Cheville Rochester, MN , Simon KimSimon Kim Rochester, MN , Robert TarrellRobert Tarrell Rochester, MN , Prabin ThapaPrabin Thapa Rochester, MN , and Igor FrankIgor Frank Rochester, MN View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1864AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Micropapillary (MP) carcinoma of the bladder is a rare variant of urothelial carcinoma (UC) which has been shown to be poorly responsive to intravesical BCG therapy, and has been associated with an aggressive natural history. The impact of MP features on survival following radical cystectomy (RC), however, continues to be defined. Here, then, we report the outcomes of MP bladder cancer patients after RC, and compare the survival of these patients to a matched cohort with pure UC. METHODS We evaluated 2,068 patients who underwent RC at our institution between 1980 and 2005. All pathologic specimens were re-reviewed by a single genitourinary pathologist. Of these, 73 (3.5%) patients had MP bladder cancer, including 62 men and 11 women. Median postoperative follow up was 9.6 years (range 4.0-21.1 years). These patients were matched in a 1:2 case-control design to patients with pure UC according to pathologic tumor stage, lymph node status, and ECOG performance status. Five-year survival was then estimated using the Kaplan-Meier method and compared using the log rank test. RESULTS Median patient age in the MP cohort was 67 years (range 43-88). MP bladder cancers were associated with a high rate of adverse pathologic features, as 48/73 patients (66%) had pT3/4 tumors, 53 (73%) had lymphovascular invasion, and 37 (50%) had pN+ disease. As such, patients with MP tumors were more likely than patients with pure UC to present with extravesical extension (66% vs. 30%; p<0.001), lymphovascular invasion (73% vs. 11%; p<0.001), and pN+ disease (50% vs 10%; p<0.001). A total of 17 MP patients (23%) received neoadjuvant and/or adjuvant chemotherapy. Interestingly, when patients with MP bladder cancer were matched to those with pure UC, no significant differences between the cohorts were noted with regard to 5-year local recurrence-free survival (66% vs. 71%; p=0.87), distant metastasis-free survival (47% vs. 58%; p=0.54), or cancer-specific survival (37% vs. 44%; p=0.41). CONCLUSIONS MP bladder cancer is associated with a high rate of extravesical and/or lymph note positive disease at RC. However, when matched to patients with pure UC, patients with MP tumors do not have an increased rate of local/distant recurrence or adverse cancer-specific survival. Additional studies are needed to further define prognostic factors for patients with MP cancers and to develop the optimal multimodal management strategy when this histology is encountered. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e574 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.Metrics Author Information Jeffrey Wang Rochester, MN More articles by this author Stephen Boorjian Rochester, MN More articles by this author John Cheville Rochester, MN More articles by this author Simon Kim Rochester, MN More articles by this author Robert Tarrell Rochester, MN More articles by this author Prabin Thapa Rochester, MN More articles by this author Igor Frank Rochester, MN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...