Radical cystectomy in non-metastatic sarcomatoid bladder cancer: A direct comparison vs urothelial bladder cancer

Stefano Tappero; Andrea Panunzio; Lukas Hohenhorst; Cristina Cano Garcia; Francesco Barletta; Mattia Piccinelli; Zhe Tian; Stefano Parodi; Alessandro Antonelli; Markus Graefen; Felix K H Chun; Alberto Briganti; Ottavio De Cobelli; Fred Saad; Shahrokh F Shariat; Nazareno Suardi; Marco Borghesi; Carlo Terrone; Pierre I Karakiewicz

doi:10.1016/j.ejso.2022.09.013

Radical cystectomy in non-metastatic sarcomatoid bladder cancer: A direct comparison vs urothelial bladder cancer

Eur J Surg Oncol. 2023 Jan;49(1):271-277. doi: 10.1016/j.ejso.2022.09.013. Epub 2022 Sep 24.

Authors

Stefano Tappero¹, Andrea Panunzio², Lukas Hohenhorst³, Cristina Cano Garcia⁴, Francesco Barletta⁵, Mattia Piccinelli⁶, Zhe Tian⁷, Stefano Parodi⁸, Alessandro Antonelli⁹, Markus Graefen¹⁰, Felix K H Chun¹¹, Alberto Briganti¹², Ottavio De Cobelli¹³, Fred Saad⁷, Shahrokh F Shariat¹⁴, Nazareno Suardi¹⁵, Marco Borghesi⁸, Carlo Terrone⁸, Pierre I Karakiewicz⁷

Affiliations

¹ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, IRCCS Policlinico San Martino, Genova, Italy; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy. Electronic address: stefano.m.tappero@gmail.com.
² Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Italy.
³ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
⁴ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Frankfurt Am Main, Germany.
⁵ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
⁶ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy.
⁷ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
⁸ Department of Urology, IRCCS Policlinico San Martino, Genova, Italy; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy.
⁹ Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Italy.
¹⁰ Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
¹¹ Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Frankfurt Am Main, Germany.
¹² Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
¹³ Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy.
¹⁴ Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan.
¹⁵ Department of Urology, Spedali Civili of Brescia, Brescia, Italy.

PMID: 36192262
DOI: 10.1016/j.ejso.2022.09.013

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: T₂N₀M₀) vs non-organ-confined (NOC: T_3-4N₀M₀ or T_anyN_1-3M₀) 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.

Keywords: Bladder cancer; Radical cystectomy; Sarcomatoid.

MeSH terms

Carcinoma, Transitional Cell*
Cystectomy / methods
Humans
Propensity Score
Sarcoma* / surgery
Urinary Bladder
Urinary Bladder Neoplasms*