The impact of plasmacytoid variant histology on the survival of patients with urothelial carcinoma of bladder after radical cystectomy Journal Article

Authors: Li, Q.; Assel, M.; Benfante, N. E.; Pietzak, E. J.; Herr, H. W.; Donat, M.; Cha, E. K.; Donahue, T. F.; Bochner, B. H.; Dalbagni, G.
Article Title: The impact of plasmacytoid variant histology on the survival of patients with urothelial carcinoma of bladder after radical cystectomy
Abstract: The presence of plasmacytoid variant of the bladder is rare and associated with higher disease burden at radical cystectomy compared with pure urothelial carcinoma. However, plasmacytoid variant was not an independent predictor of overall survival on multivariable analysis. © 2017 European Association of Urology Background: The clinical significance of the plasmacytoid variant (PCV) in urothelial carcinoma (UC) is currently lacking. Objective: To compare clinical outcomes of patients with any PCV with that of patients with pure UC treated with radical cystectomy (RC). Design, setting, and participants: We identified 98 patients who had pathologically confirmed PCV UC and 1312 patients with pure UC and no variant history who underwent RC at our institution between 1995 and 2014. Outcome measurements and statistical analysis: Univariable and multivariable Cox regression and Cox proportional hazards regression to determine if PCV was associated with overall survival (OS). Results and limitations: Patients with PCV UC were more likely to have advanced tumor stage (p = 0.001), positive lymph nodes (p = 0.038), and receive neoadjuvant chemotherapy than those with pure UC (46% vs 22%, p < 0.0001). The rate of positive soft tissue surgical margins was over five times greater in the PCV UC group compared with the pure UC group (21% vs 4.1%, respectively, p < 0.0001). Median OS for the pure UC versus the PCV patients were 8 yr and 3.8 yr, respectively. On univariable analysis, PCV was associated with an increased risk of overall mortality (hazard ratio = 1.34, 95% confidence interval: 1.02–1.78, p = 0.039). However, on multivariable analysis adjusted for age, sex, neoadjuvant chemotherapy received, lymph node status, pathologic stage, and soft margin status, the association between PCV and OS was no longer significant (hazard ratio = 1.06, 95% confidence interval: 0.78, 1.43, p = 0.7). This retrospective study is limited by the lack of pathological reanalysis, and the impact of other concurrent mixed histology cannot be determined in this study. Conclusions: Patients with PCV features have a higher disease burden at RC compared with those with pure UC. However, PCV was not an independent predictor of survival after RC on multivariable analysis, suggesting that PCV histology should not be used as an independent prognostic factor. Patient summary: Plasmacytoid urothelial carcinoma is a rare and aggressive form of bladder cancer. Patients with plasmacytoid urothelial carcinoma had worse adverse pathologic features, but this was not associated with worse overall mortality when compared with patients with pure urothelial carcinoma. © 2017 European Association of Urology
Keywords: cancer survival; controlled study; human tissue; aged; major clinical study; overall survival; clinical feature; advanced cancer; cancer risk; cancer staging; follow up; disease association; cohort analysis; retrospective study; bladder cancer; histology; cancer mortality; patient identification; soft tissue; lymph node; radical cystectomy; cystectomy; neoadjuvant chemotherapy; surgical margin; clinical outcome; disease burden; human; male; female; article; plasmacytoid variant; urothelial carcinoma of bladder; plasmacytoid urothelial carcinoma; plasmacytoma cell line
Journal Title: European Urology Focus
Volume: 5
Issue: 1
ISSN: 2405-4569
Publisher: European Association of Urology  
Date Published: 2019-01-01
Start Page: 104
End Page: 108
Language: English
DOI: 10.1016/j.euf.2017.06.013
PUBMED: 28753857
PROVIDER: scopus
Notes: Article -- Export Date: 1 March 2019 -- Source: Scopus
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MSK Authors
  1. Guido Dalbagni
    251 Dalbagni
  2. Sherri M Donat
    135 Donat
  3. Bernard Bochner
    324 Bochner
  4. Harry W Herr
    407 Herr
  5. Timothy Francis Donahue
    17 Donahue
  6. Melissa Jean Assel
    39 Assel
  7. Eugene K. Cha
    58 Cha
  8. Qiang   Li
    8 Li
  9. Eugene J Pietzak
    20 Pietzak