Adjuvant Chemotherapy and Survival After Radical Cystectomy in Histologic Subtype Bladder Cancer.

Patients with histologic subtype bladder cancer (HSBC) suffer worse outcomes than those with conventional urothelial carcinoma (UC). We sought to characterize the use of adjuvant chemotherapy (AC) in HSBC after radical cystectomy (RC) using the National Cancer Database (NCDB). We retrospectively queried the NCDB (2006-2019) for patients with non-metastatic bladder cancer (BC) who underwent RC (N = 45,797). Patients were stratified by histologic subtype and receipt of AC. Multivariable logistic regression determined associations of demographic and clinicopathologic features with receipt of AC. Multivariable Cox regression evaluated associations between receipt of any AC and overall survival (OS). We identified 4,469 patients with HSBC classified as squamous, adenocarcinoma, small cell, sarcomatoid, micropapillary, or plasmacytoid. Squamous comprised 31% of the HSBC cohort, followed by small cells and micropapillary. Black patients were presented with a higher prevalence of adenocarcinoma (119/322, 37.0%). Use of AC was highest in plasmacytoid and small cell (30% each) and lowest in squamous (11%). Neuroendocrine histology was independently associated with greater odds of receiving AC (HR 1.6, 95% CI 1.37-1.87), while squamous cell histology was associated with lower odds (HR 0.61, 95% CI 0.53-0.71). On multivariable Cox regression analysis, treatment with AC was associated with significantly longer OS (HR 0.69, 95% CI 0.59-0.81) and for squamous, sarcomatoid, and micropapillary cohorts after stratified by subtype. AC was variably used among patients with HSBC and was associated with OS benefit in such patients.

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Disclosure Elizabeth L. Koehne: no conflicts to disclose. Dimitra R. Bakaloudi: no conflicts to disclose. Fady Ghali: no conflicts to disclose. Yaw Nyame: no conflicts to disclose. George R. Schade: Advisor for ImmunityBio and Consultant for EDAP TMS. Petros Grivas: consulting for 4D Pharma, Abbvie, Aadi Bioscience, Asieris Pharmaceuticals, Astellas, AstraZeneca, BostonGene, Bristol Myers Squibb, CG Oncology, Dyania Health, Exelixis, Fresenius Kabi, G1 Therapeutics, Genentech, Gilead Sciences, Guardant Health, ImmunityBio, Infinity Pharmaceuticals, Janssen, Lucence, Merck KGaA, Mirati Therapeutics, MSD, Pfizer, PureTech, QED Therapeutics, Regeneron, Roche, Seattle Genetics, Silverback Therapeutics, Strata Oncology, UroGen Pharma; institutional research funding from ALX Oncology, Acrivon Therapeutics, Bavarian Nordic, Bristol Myers Squibb, Clovis Oncology, Debiopharm Group, G1 Therapeutics, Gilead Sciences, GSK, Merck KGaA, Mirati Therapeutics, MSD, Pfizer, QED Therapeutics. Todd A. Yezefski: no conflicts to disclose. Jessica E. Hawley: paid consultant to Seagen, Daiichi Sankyo, and ImmunityBio and has received sponsored research funding to her institution from Astra Zeneca, Bristol Meyers Squibb, Crescendo Biologics, Macrogenics, Janssen, and Vaccitech. Evan Y. Yu: consulting for Bayer, Janssen, Merck, AAA Novartis, Aadi Bioscience, Oncternal, Bristol Myers Squibb, Loxo. Institutional research support from Bayer, Daiichi-Sankyo, Dendreon, Merck, Taiho, Seattle Genetics, Blue Earth, Lantheus, Surface, and Tyra. Andrew C. Hsieh: no conflicts to disclose. R Bruce Montgomery: Research Funding—AstraZeneca, Janssen Oncology, Clovis Oncology, Astellas Pharma, Beigene. Sarah P. Psutka: Research funding—NIA, BCAN, Janssen (Global PI SunRise 4), Steba Bio Tech (Site PI: ENLIGHTED Trial); Advisory Board—ImmunityBio, Janssen. John L. Gore: Advisor, Seagen Pharmaceuticals, Inc.; Advisor, ImmunityBio. Jonathan L. Wright: Royalites—UpToDate; Clinical Trials—Merck, Nucleix, Janssen, Pacific Edge, Seagen, Veracyte; Consulting—ImmunityBio, Pacific Edge.