Table 3.
Delphi results regarding proposed statement for the management of bladder cancer with variant histologies
| Proposed statements | Level of agreement |
Relevant stakeholder groups | Consensus level (see Table 2) | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Urologists (N-=-45) |
Oncologists (N-=-32) |
Others (N-=-20) |
||||||||||||
| D (%) | E (%) | A (%) | U (n) | D (%) | E (%) | A (%) | U (n) | D (%) | E (%) | A (%) | U (n) | |||
| 1. T1 high-grade bladder urothelial carcinoma (established after complete TURBT and/or re-TURBT) with micropapillary variant should be treated with immediate radical cystectomy | 7 | 11 | 82 | 0 | 44 | 22 | 33 | 5 | 36 | 27 | 36 | 9 | Ur+O | 3 |
| 2. T1 high-grade bladder urothelial carcinoma (established after complete TURBT and/or re-TURBT) with plasmacytoid or sarcomatoid or nested variant should be treated with immediate radical cystectomy | 2 | 7 | 91 | 0 | 22 | 7 | 70 | 5 | 27 | 18 | 55 | 9 | Ur+O | 3 |
| 3. T1 high-grade bladder urothelial carcinoma (established after complete TURBT and/or re-TURBT) with squamous or glandular variant or nested variant should be treated with immediate radical cystectomy | 16 | 20 | 64 | 0 | 41 | 7 | 52 | 5 | 64 | 18 | 18 | 9 | Ur+O | 3 |
| 4. Muscle-invasive bladder urothelial carcinoma with micropapillary variant should be treated with primary radical cystectomy and lymphadenectomy | 11 | 11 | 78 | 0 | 30 | 17 | 53 | 2 | 8 | 8 | 83 | 8 | Ur+On+O | 3 |
| 5. Muscle-invasive bladder urothelial carcinoma with plasmacytoid variant should be treated with primary radical cystectomy and lymphadenectomy | 9 | 9 | 82 | 0 | 29 | 19 | 52 | 1 | 17 | 17 | 67 | 8 | Ur+On+O | 3 |
| 6. Muscle-invasive bladder urothelial carcinoma with squamous or glandular variant should be treated with primary radical cystectomy and lymphadenectomy | 16 | 4 | 80 | 0 | 20 | 23 | 57 | 2 | 17 | 25 | 58 | 8 | Ur+On+O | 3 |
| 7. Bladder urothelial carcinoma with small-cell neuroendocrine variant should be treated with neoadjuvant chemotherapy followed by consolidating local therapy | 2 | 2 | 96 | 0 | 0 | 0 | 100 | 1 | 0 | 0 | 100 | 8 | Ur+On+O | 1 |
| 8. Muscle-invasive pure squamous cell carcinoma of the bladder should be treated with primary radical cystectomy and lymphadenectomy | 2 | 0 | 98 | 0 | 0 | 16 | 84 | 0 | 8 | 17 | 75 | 8 | Ur+On+O | 1 |
| 9. Muscle-invasive pure adenocarcinoma of the bladder should be treated with primary radical cystectomy and lymphadenectomy | 4 | 2 | 93 | 0 | 3 | 9 | 88 | 0 | 8 | 8 | 83 | 8 | Ur+On+O | 1 |
| 10. Radiotherapy (with or without radio-sensitising chemotherapy) is an effective therapy for patients with muscle-invasive urothelial carcinoma with variant histologies | 58 | 40 | 2 | 0 | 13 | 28 | 59 | 0 | 40 | 30 | 30 | 10 | Ur+On | 3 |
| 11. Muscle-invasive small-cell neuroendocrine variant of bladder urothelial carcinoma should receive preventive brain irradiation to avoid brain recurrence | 76 | 20 | 4 | 0 | 74 | 19 | 6 | 1 | 86 | 14 | 0 | 13 | On | 1 |
| 12. Differentiating between urachal and non-urachal subtypes of adenocarcinoma is essential when making treatment decisions | 7 | 14 | 80 | 1 | 6 | 19 | 74 | 1 | 0 | 8 | 92 | 8 | Ur+On+O | 1 |
| 13. Patients with pT3/4 pure adenocarcinoma or squamous carcinoma of the bladder should receive perioperative radiotherapy | 75 | 23 | 2 | 1 | 58 | 13 | 29 | 1 | 14 | 29 | 57 | 13 | Ur+On | 3 |
| 14. Checkpoint inhibitor therapy is effective in metastatic urothelial carcinoma with variant histology | 5 | 56 | 40 | 2 | 7 | 37 | 56 | 5 | 0 | 75 | 25 | 12 | On | 3 |
Statements highlighted in green achieved level 1 consensus and those in yellow failed to reach consensus (level 3) as part of the Delphi survey; numbers highlighted in red indicate where the level of agreement among individual stakeholder groups reached ≥70% (see Table 2 for details of consensus level criteria). Statements indicated in bold were subsequently reviewed at the consensus conference with revised statements and voting shown in Table 4.
A, agree; D, disagree; E, equivocal; O, others (includes specialities in Nuclear Medicine, Pathology, Radiology, Specialist Nurse, Clinical Oncology); On, Oncologists; TURBT, transurethral resection of bladder tumour; U, unable to respond; Ur, Urologists.