Table 9. Studies reporting outcomes with radical cystectomy + adjuvant chemotherapy (survival outcomes only).
| 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 |
|---|---|---|---|---|---|---|
| Monn (18) (2015), n=411 (VH n=411) | 38 months | UC with VH cases at RC had 1.69-times increased risk of disease-specific mortality (P=0.030) and 1.57-times increased adjusted risk of all-cause mortality (P=0.027) compared to UC with divergent squamous differentiation | UC with VH was associated with worse survival outcomes regardless of pathologic stage, NAC or adjuvant chemotherapy compared to UC with divergent squamous differentiation | |||
| Mitra (21) (2014), n=1,762 (VH n=259) | 15.2 years for cases, 11.0 years for controls, 12.2 for independent cohort | No differences in survival outcomes between cases and controls were observed | Higher pathologic T stage, age and hydronephrosis were associated with increased mortality risk | Patients with squamous or glandular or both differentiation had survival outcomes similar to conventional UC after cystectomy. they however presented with a higher pathologic stage | ||
| This was a case-control analysis, cases were stratified into three groups:1. Squamous differentiation2. Glandular differentiation3. Squamous + glandular differentiation | Pathologic stage was predictive of outcome in cases with differentiation | In glandular differentiation, non-administration of adjuvant chemotherapy was associated with worse OS | ||||
| Controls were conventional UC patients matched 1:1 to cases and an independent cohort of 1,244 conventional UC | ||||||
| Masson-Lecomte (24) (2015), n=266 (VH n=31) | Comparing patients with micropapillary VH with conventional UC, median survival was 29 vs. 31 months. Five-year RFS (15% vs. 42%; P=0.007), five-year CSS (24% vs. 47%; P=0.058) | Positive tissue margin and high ASA score was associated with worse RFS in univariate and multivariate analysis. Age, lymph node positivity and a positive soft tissue margin were associated with CSS in univariate and multivariate analysis | Micropapillary histologic subtype was associated with higher disease recurrence rates after RC and platinum-based adjuvant chemotherapy compared to conventional UC | |||
| Patients with MIBC were treated with RC and adjuvant platinum based chemotherapy. | ||||||
| Keck (38) (2013), n=205 (VH n=27) | Plasmacytoid UC had significantly worse outcomes compared to micropapillary and conventional UC after RC and adjuvant cisplatin-based chemotherapy with a median OS of 27.4 months | |||||
| Zamboni (40) (2021), n=3,963 (VH n=906) | 32 months | Adjuvant chemotherapy failed to improve survival outcomes in any of histologic variants (P>0.05) | ||||
| 723 patients received RC and adjuvant chemotherapy |
VH, variant histology; UC, urothelial carcinoma; NAC, neoadjuvant chemotherapy; RC, radical cystectomy; MIBC, muscle invasive bladder cancer; OS, overall survival; ASA, American Society of Anesthesiologists; RFS, recurrence free survival; CSS, cancer specific survival.