Oncologic Surveillance for Variant Histology Bladder Cancer after Radical Cystectomy

No AccessJournal of UrologyAdult Urology1 Oct 2021Oncologic Surveillance for Variant Histology Bladder Cancer after Radical Cystectomy Alberto Martini, Luca Afferi, Stefania Zamboni, Julianne G. Schultz, Chiara Lonati, Agostino Mattei, R. Jeffrey Karnes, Matteo Soligo, Armando Stabile, Ettore Di Trapani, Ottavio De Cobelli, Giuseppe Simone, Claudio Simeone, Mario Alvarez-Maestro, Giorgio Gandaglia, Andrea Gallina, Renzo Colombo, Alberto Briganti, Francesco Montorsi, Evanguelos Xylinas, Shahrokh F. Shariat, and Marco Moschini Alberto MartiniAlberto Martini *Correspondence: Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Via Olgettina, 60-20132, Milan , Italy telephone: 02.26435664, FAX: 02.26435659; E-mail Address: [email protected] Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy More articles by this author , Luca AfferiLuca Afferi Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland More articles by this author , Stefania ZamboniStefania Zamboni Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy More articles by this author , Julianne G. SchultzJulianne G. Schultz Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy More articles by this author , Chiara LonatiChiara Lonati Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland More articles by this author , Agostino MatteiAgostino Mattei Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland More articles by this author , R. Jeffrey KarnesR. Jeffrey Karnes Department of Urology, Mayo Clinic, Rochester, Minnesota Financial interest and/or other relationship with Decipher Biosciences. More articles by this author , Matteo SoligoMatteo Soligo Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author , Armando StabileArmando Stabile Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy More articles by this author , Ettore Di TrapaniEttore Di Trapani Department of Urology, European Institute of Oncology, Milan, Italy More articles by this author , Ottavio De CobelliOttavio De Cobelli Department of Urology, European Institute of Oncology, Milan, Italy Department of Oncology and Hematology, University of Milan, Italy More articles by this author , Giuseppe SimoneGiuseppe Simone Department of Urology, IRCCS “Regina Elena” National Cancer Institute, Rome, Italy More articles by this author , Claudio SimeoneClaudio Simeone Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy More articles by this author , Mario Alvarez-MaestroMario Alvarez-Maestro Department of Urology, Instituto de Investigación Hospital Universitario Louisiana Paz (IdiPAZ), Madrid, Spain More articles by this author , Giorgio GandagliaGiorgio Gandaglia Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy More articles by this author , Andrea GallinaAndrea Gallina Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy More articles by this author , Renzo ColomboRenzo Colombo Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy More articles by this author , Alberto BrigantiAlberto Briganti Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy More articles by this author , Francesco MontorsiFrancesco Montorsi Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy More articles by this author , Evanguelos XylinasEvanguelos Xylinas Department of Urology; Bichat Hospital, Paris Descartes University, Paris, France More articles by this author , Shahrokh F. ShariatShahrokh F. Shariat Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic More articles by this author , and Marco MoschiniMarco Moschini * E-mail Address: [email protected] Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy More articles by this author on behalf of the European Association of Urology–Young Academic Urologists (EAU-YAU), Urothelial Carcinoma Working Group View All Author Informationhttps://doi.org/10.1097/JU.0000000000001886AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Presently, major guidelines do not provide specific recommendations on oncologic surveillance for patients who harbor variant histology (VH) bladder cancer (BCa) at radical cystectomy. We aimed to create a personalized followup scheme that dynamically weighs other cause mortality (OCM) vs the risk of recurrence for VH BCa, and to compare it with a similar one for pure urothelial carcinoma (pUC). Materials and Methods: Within a multi-institutional registry, 528 and 1,894 patients with VH BCa and pUC, respectively, were identified. The Weibull regression was used to detect the time points after which the risk of OCM exceeded the risk of recurrence during followup. The risk of OCM over time was stratified based on age and comorbidities, and the risk of recurrence on pathological stage and recurrence site. Results: Individuals with VH had a higher risk of recurrence (recurrence-free survival 30% vs 51% at 10 years, p <0.001) and shorter median time to recurrence (88 vs 123 months, p <0.01) relative to pUC. Among VH, micropapillary variant conferred the greatest risk of recurrence on the abdomen and lungs, and mixed variants carried the greatest risk of metastasizing to bones and other sites compared to pUC. Overall, surveillance should be continued for a longer time for individuals with VH BCa. Notably, patients younger than 60 years with VH and pT0/Ta/T1/N0 at radical cystectomy should continue oncologic surveillance after 10 years vs 6.5 years for pUC individuals. Conclusions: VH BCa is associated with greater recurrence risk than pUC. A followup scheme that is valid for pUC should not be applied to individuals with VH. Herein, we present a personalized approach for surveillance that may allow an improved shared decision. References 1. : What is the significance of variant histology in urothelial carcinoma?Eur Urol Focus 2020; 6: 653. Google Scholar 2. : Comprehensive assessment of immuno-oncology biomarkers in adenocarcinoma, urothelial carcinoma, and squamous-cell carcinoma of the bladder. Eur Urol 2020; 77: 548. Google Scholar 3. : EAU-ESMO consensus statements on the management of advanced and variant bladder cancer—an international collaborative multistakeholder effort: under the auspices of the EAU-ESMO guidelines committees. Eur Urol 2020; 77: 223. Google Scholar 4. : Characteristics and clinical significance of histological variants of bladder cancer. Nat Rev Urol 2017; 14: 651. Google Scholar 5. : What is the prognostic and clinical importance of urothelial and nonurothelial histological variants of bladder cancer in predicting oncological outcomes in patients with muscle-invasive and metastatic bladder cancer? A European Association of Urology Muscle Invasive and Metastatic Bladder Cancer Guidelines Panel systematic review. Eur Urol Oncol 2019; 2: 625. Google Scholar 6. : EAU Guidelines on Muscle-Invasive and Metastatic Bladder Cancer. Arnhem, Netherlands: European Association of Urology 2019. Google Scholar 7. : NCCN guidelines insights: bladder cancer, version 5.2018. J Natl Compr Canc Netw 2018; 16: 1041. Google Scholar 8. : ACR Appropriateness Criteria® post-treatment surveillance of bladder cancer. J Am Coll Radiol, suppl., 2019; 16: S417. Google Scholar 9. : Oncologic surveillance following radical cystectomy: an individualized risk-based approach. World J Urol 2017; 35: 1863. Google Scholar 10. : Evaluation of current surveillance guidelines following radical cystectomy and proposal of a novel risk-based approach. Urol Oncol 2015; 33: 339.e331. Google Scholar 11. : Burden of multiple chronic conditions among patients with urological cancer. J Urol 2018; 199: 543. Link, Google Scholar 12. : Cancer statistics, 2020. CA Cancer J Clin 2020; 70: 7. Google Scholar 13. : The 2016 WHO classification of tumours of the urinary system and male genital organs—part B: prostate and bladder tumours. Eur Urol 2016; 70: 106. Google Scholar 14. : Early mortality in patients with muscle-invasive bladder cancer undergoing cystectomy in the United States. JNCI Cancer Spectr 2018; 2: pky075. Google Scholar 15. : Prediction of 90-day mortality after radical cystectomy for bladder cancer in a prospective European multicenter cohort. Eur Urol 2014; 66: 156. Google Scholar 16. : Use of sigmoid colon in orthotopic neobladder reconstruction: long-term results. Int J Urol 2016; 23: 984. Google Scholar 17. : On the use and utility of the Weibull model in the analysis of survival data. Control Clin Trials 2003; 24: 682. Google Scholar 18. : Oncologic surveillance after surgical resection for renal cell carcinoma: a novel risk-based approach. J Clin Oncol 2015; 33: 4151. Google Scholar 19. : Management of muscle invasive, locally advanced and metastatic urothelial carcinoma of the bladder: a literature review with emphasis on the role of surgery. Transl Androl Urol 2016; 5: 735. Google Scholar 20. : Treatment of muscle-invasive bladder cancer: a systematic review. Cancer 2016; 122: 842. Google Scholar 21. : The natural history of untreated muscle-invasive bladder cancer. BJU Int 2020; 125: 270. Google Scholar 22. : Contemporary survival rates for muscle-invasive bladder cancer treated with definitive or non-definitive therapy. Clin Genitourin Cancer 2019; 17: e488. Google Scholar 23. : Effects of age and comorbidity on treatment and survival of patients with muscle-invasive bladder cancer. Int J Cancer 2014; 135: 905. Google Scholar 24. : Intensive follow-up for women with breast cancer: review of clinical, economic and patient's preference domains through evidence to decision framework. Health Qual Life Outcomes 2017; 15: 206. Google Scholar 25. GIVIO Investigators: Impact of follow-up testing on survival and health-related quality of life in breast cancer patients. A multicenter randomized controlled trial. The GIVIO Investigators. JAMA 1994; 271: 1587. Google Scholar 26. : Neoadjuvant chemotherapy prior to radical cystectomy for muscle-invasive bladder cancer with variant histology. Cancer 2017; 123: 4346. Google Scholar 27. : Pathological response to neoadjuvant chemotherapy for muscle-invasive micropapillary bladder cancer. BJU Int 2013; 111: E325. Google Scholar 28. : Pathological and survival outcomes associated with variant histology bladder cancers managed by cystectomy with or without neoadjuvant chemotherapy. J Urol 2021; 205: 100. Link, Google Scholar 29. : Neoadjuvant chemotherapy in variant histology bladder cancer: current evidence. Eur Urol Focus 2020; 6: 639. Google Scholar 30. : Adjuvant chemotherapy is ineffective in patients with bladder cancer and variant histology treated with radical cystectomy with curative intent. World J Urol 2021; 39: 1947. Google Scholar Funded by the National Institutes of Health (GS, CS). © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited BySmith J (2021) This Month in Adult UrologyJournal of Urology, VOL. 206, NO. 4, (799-800), Online publication date: 1-Oct-2021. Volume 206Issue 4October 2021Page: 885-893Supplementary Materials Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.Keywordssuvival analysisrecurrencecystectomyfollow-up studiesurinary bladder neoplasmsMetricsAuthor Information Alberto Martini Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy *Correspondence: Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Via Olgettina, 60-20132, Milan , Italy telephone: 02.26435664, FAX: 02.26435659; E-mail Address: [email protected] More articles by this author Luca Afferi Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland More articles by this author Stefania Zamboni Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy More articles by this author Julianne G. Schultz Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy More articles by this author Chiara Lonati Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland More articles by this author Agostino Mattei Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland More articles by this author R. Jeffrey Karnes Department of Urology, Mayo Clinic, Rochester, Minnesota Financial interest and/or other relationship with Decipher Biosciences. More articles by this author Matteo Soligo Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author Armando Stabile Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy More articles by this author Ettore Di Trapani Department of Urology, European Institute of Oncology, Milan, Italy More articles by this author Ottavio De Cobelli Department of Urology, European Institute of Oncology, Milan, Italy Department of Oncology and Hematology, University of Milan, Italy More articles by this author Giuseppe Simone Department of Urology, IRCCS “Regina Elena” National Cancer Institute, Rome, Italy More articles by this author Claudio Simeone Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy More articles by this author Mario Alvarez-Maestro Department of Urology, Instituto de Investigación Hospital Universitario Louisiana Paz (IdiPAZ), Madrid, Spain More articles by this author Giorgio Gandaglia Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy More articles by this author Andrea Gallina Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy More articles by this author Renzo Colombo Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy More articles by this author Alberto Briganti Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy More articles by this author Francesco Montorsi Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy More articles by this author Evanguelos Xylinas Department of Urology; Bichat Hospital, Paris Descartes University, Paris, France More articles by this author Shahrokh F. Shariat Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic More articles by this author Marco Moschini Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy * E-mail Address: [email protected] More articles by this author Expand All Funded by the National Institutes of Health (GS, CS). Advertisement PDF DownloadLoading ...