Table 5. Studies on sarcomatoid differentiation reporting outcomes with either neoadjuvant chemotherapy or upfront radical cystectomy.

Author (year)	Pathologic complete response	Pathologic downstaging	Median follow up after cystectomy	Survival outcomes after cystectomy	Major independent factor(s) other than histologic phenotype affecting response/outcomes analyzed	Comments
Almassi (11) (2021), n=1,853 (VH n=259)	Comparing UC with sarcomatoid differentiation with conventional UC, pCR rate 20% vs. 24% (P=0.6)	Pathologic downstaging to <T2 rate 24% vs. 31% (P=0.6), comparing between UC with sarcomatoid differentiation and conventional UC	5.8 years	Sarcomatoid differentiation was associated with inferior survival outcomes compared to conventional UC: five-year RFS of 45% vs. 71%, CSS estimate at five years of 51% vs. 75%, OS estimate at five years of 45% vs. 63%. In the sarcomatoid differentiation group, comparing patients who received NAC vs. those who did not, five-year RFS after RC was 55% vs. 40% (P=0.1)	–	Pathologic response rates to NAC between UC with sarcomatoid differentiation and conventional UC was similar. UC with sarcomatoid differentiation was associated with inferior survival outcomes but greater survival among patients receiving NAC

UC, urothelial carcinoma; VH, variant histology; NAC, neoadjuvant chemotherapy; pCR, pathologic complete response; RFS, recurrence free survival; CSS, cancer specific survival; OS, overall survival.