Outcomes following radical cystectomy for nested variant of urothelial carcinoma

A matched cohort analysis

Brian J. Linder, Igor Frank, John C. Cheville, R. Houston Thompson, Prabin Thapa, Robert F. Tarrell, Stephen A. Boorjian

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Purpose: We evaluated oncological outcomes after radical cystectomy in patients with the nested variant of urothelial carcinoma and compared survival to that in patients with pure urothelial carcinoma of the bladder. Materials and Methods: We identified 52 patients with the nested variant who were treated with radical cystectomy between 1980 and 2004. Pathological specimens were re-reviewed by a single genitourinary pathologist. Patients were matched 1:2 by age, gender, ECOG (Eastern Cooperative Oncology Group) performance status, pathological tumor stage and nodal status to patients with pure urothelial carcinoma. Survival was estimated using the Kaplan-Meier method and compared with the log rank test. Results: Patients with the nested variant had a median age of 69.5 years (IQR 62, 74) and a median postoperative followup of 10.8 years (IQR 9.3, 11.2). Nested variant cancer was associated with a high rate of adverse pathological features since 36 patients (69%) had pT3-T4 disease and 10 (19%) had nodal invasion. Eight patients (15%) with nested variant cancer received perioperative chemotherapy. When patients with the nested variant were matched to a cohort with pure urothelial carcinoma, no significant differences were noted in 10-year local recurrence-free survival (83% vs 80%, p = 0.46) or 10-year cancer specific survival (41% vs 46%, p = 0.75). Conclusions: The nested variant of urothelial carcinoma is associated with a high rate of locally advanced disease at radical cystectomy. However, when stage matched to patients with pure urothelial carcinoma, patients with the nested variant did not have an increased rate of recurrence or adverse survival. Further studies are required to validate these findings and guide the optimal multimodal treatment approach to these patients.

Original languageEnglish (US)
Pages (from-to)1670-1675
Number of pages6
JournalJournal of Urology
Volume189
Issue number5
DOIs
StatePublished - May 2013

Fingerprint

Cystectomy
Cohort Studies
Carcinoma
Survival
Neoplasms
Recurrence
Combined Modality Therapy
Urinary Bladder

Keywords

  • carcinoma
  • cystectomy
  • mortality
  • urinary bladder
  • urothelium

ASJC Scopus subject areas

  • Urology

Cite this

Linder, B. J., Frank, I., Cheville, J. C., Thompson, R. H., Thapa, P., Tarrell, R. F., & Boorjian, S. A. (2013). Outcomes following radical cystectomy for nested variant of urothelial carcinoma: A matched cohort analysis. Journal of Urology, 189(5), 1670-1675. https://doi.org/10.1016/j.juro.2012.11.006

Outcomes following radical cystectomy for nested variant of urothelial carcinoma : A matched cohort analysis. / Linder, Brian J.; Frank, Igor; Cheville, John C.; Thompson, R. Houston; Thapa, Prabin; Tarrell, Robert F.; Boorjian, Stephen A.

In: Journal of Urology, Vol. 189, No. 5, 05.2013, p. 1670-1675.

Research output: Contribution to journalArticle

Linder, BJ, Frank, I, Cheville, JC, Thompson, RH, Thapa, P, Tarrell, RF & Boorjian, SA 2013, 'Outcomes following radical cystectomy for nested variant of urothelial carcinoma: A matched cohort analysis', Journal of Urology, vol. 189, no. 5, pp. 1670-1675. https://doi.org/10.1016/j.juro.2012.11.006
Linder, Brian J. ; Frank, Igor ; Cheville, John C. ; Thompson, R. Houston ; Thapa, Prabin ; Tarrell, Robert F. ; Boorjian, Stephen A. / Outcomes following radical cystectomy for nested variant of urothelial carcinoma : A matched cohort analysis. In: Journal of Urology. 2013 ; Vol. 189, No. 5. pp. 1670-1675.
@article{937ac3a5d7a641a284edbc00c237ec7a,
title = "Outcomes following radical cystectomy for nested variant of urothelial carcinoma: A matched cohort analysis",
abstract = "Purpose: We evaluated oncological outcomes after radical cystectomy in patients with the nested variant of urothelial carcinoma and compared survival to that in patients with pure urothelial carcinoma of the bladder. Materials and Methods: We identified 52 patients with the nested variant who were treated with radical cystectomy between 1980 and 2004. Pathological specimens were re-reviewed by a single genitourinary pathologist. Patients were matched 1:2 by age, gender, ECOG (Eastern Cooperative Oncology Group) performance status, pathological tumor stage and nodal status to patients with pure urothelial carcinoma. Survival was estimated using the Kaplan-Meier method and compared with the log rank test. Results: Patients with the nested variant had a median age of 69.5 years (IQR 62, 74) and a median postoperative followup of 10.8 years (IQR 9.3, 11.2). Nested variant cancer was associated with a high rate of adverse pathological features since 36 patients (69{\%}) had pT3-T4 disease and 10 (19{\%}) had nodal invasion. Eight patients (15{\%}) with nested variant cancer received perioperative chemotherapy. When patients with the nested variant were matched to a cohort with pure urothelial carcinoma, no significant differences were noted in 10-year local recurrence-free survival (83{\%} vs 80{\%}, p = 0.46) or 10-year cancer specific survival (41{\%} vs 46{\%}, p = 0.75). Conclusions: The nested variant of urothelial carcinoma is associated with a high rate of locally advanced disease at radical cystectomy. However, when stage matched to patients with pure urothelial carcinoma, patients with the nested variant did not have an increased rate of recurrence or adverse survival. Further studies are required to validate these findings and guide the optimal multimodal treatment approach to these patients.",
keywords = "carcinoma, cystectomy, mortality, urinary bladder, urothelium",
author = "Linder, {Brian J.} and Igor Frank and Cheville, {John C.} and Thompson, {R. Houston} and Prabin Thapa and Tarrell, {Robert F.} and Boorjian, {Stephen A.}",
year = "2013",
month = "5",
doi = "10.1016/j.juro.2012.11.006",
language = "English (US)",
volume = "189",
pages = "1670--1675",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Outcomes following radical cystectomy for nested variant of urothelial carcinoma

T2 - A matched cohort analysis

AU - Linder, Brian J.

AU - Frank, Igor

AU - Cheville, John C.

AU - Thompson, R. Houston

AU - Thapa, Prabin

AU - Tarrell, Robert F.

AU - Boorjian, Stephen A.

PY - 2013/5

Y1 - 2013/5

N2 - Purpose: We evaluated oncological outcomes after radical cystectomy in patients with the nested variant of urothelial carcinoma and compared survival to that in patients with pure urothelial carcinoma of the bladder. Materials and Methods: We identified 52 patients with the nested variant who were treated with radical cystectomy between 1980 and 2004. Pathological specimens were re-reviewed by a single genitourinary pathologist. Patients were matched 1:2 by age, gender, ECOG (Eastern Cooperative Oncology Group) performance status, pathological tumor stage and nodal status to patients with pure urothelial carcinoma. Survival was estimated using the Kaplan-Meier method and compared with the log rank test. Results: Patients with the nested variant had a median age of 69.5 years (IQR 62, 74) and a median postoperative followup of 10.8 years (IQR 9.3, 11.2). Nested variant cancer was associated with a high rate of adverse pathological features since 36 patients (69%) had pT3-T4 disease and 10 (19%) had nodal invasion. Eight patients (15%) with nested variant cancer received perioperative chemotherapy. When patients with the nested variant were matched to a cohort with pure urothelial carcinoma, no significant differences were noted in 10-year local recurrence-free survival (83% vs 80%, p = 0.46) or 10-year cancer specific survival (41% vs 46%, p = 0.75). Conclusions: The nested variant of urothelial carcinoma is associated with a high rate of locally advanced disease at radical cystectomy. However, when stage matched to patients with pure urothelial carcinoma, patients with the nested variant did not have an increased rate of recurrence or adverse survival. Further studies are required to validate these findings and guide the optimal multimodal treatment approach to these patients.

AB - Purpose: We evaluated oncological outcomes after radical cystectomy in patients with the nested variant of urothelial carcinoma and compared survival to that in patients with pure urothelial carcinoma of the bladder. Materials and Methods: We identified 52 patients with the nested variant who were treated with radical cystectomy between 1980 and 2004. Pathological specimens were re-reviewed by a single genitourinary pathologist. Patients were matched 1:2 by age, gender, ECOG (Eastern Cooperative Oncology Group) performance status, pathological tumor stage and nodal status to patients with pure urothelial carcinoma. Survival was estimated using the Kaplan-Meier method and compared with the log rank test. Results: Patients with the nested variant had a median age of 69.5 years (IQR 62, 74) and a median postoperative followup of 10.8 years (IQR 9.3, 11.2). Nested variant cancer was associated with a high rate of adverse pathological features since 36 patients (69%) had pT3-T4 disease and 10 (19%) had nodal invasion. Eight patients (15%) with nested variant cancer received perioperative chemotherapy. When patients with the nested variant were matched to a cohort with pure urothelial carcinoma, no significant differences were noted in 10-year local recurrence-free survival (83% vs 80%, p = 0.46) or 10-year cancer specific survival (41% vs 46%, p = 0.75). Conclusions: The nested variant of urothelial carcinoma is associated with a high rate of locally advanced disease at radical cystectomy. However, when stage matched to patients with pure urothelial carcinoma, patients with the nested variant did not have an increased rate of recurrence or adverse survival. Further studies are required to validate these findings and guide the optimal multimodal treatment approach to these patients.

KW - carcinoma

KW - cystectomy

KW - mortality

KW - urinary bladder

KW - urothelium

UR - http://www.scopus.com/inward/record.url?scp=84876291775&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84876291775&partnerID=8YFLogxK

U2 - 10.1016/j.juro.2012.11.006

DO - 10.1016/j.juro.2012.11.006

M3 - Article

VL - 189

SP - 1670

EP - 1675

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 5

ER -