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Sekar RR, Diamantopoulos LN, Bakaloudi DR, Khaki AR, Grivas P, Winters BR, Vakar-Lopez F, Tretiakova MS, Psutka SP, Holt SK, Gore JL, Lin DW, Schade GR, Hsieh AC, Lee JK, Yezefski T, Schweizer MT, Cheng HH, Yu EY, True LD, Montgomery RB, Wright JL. Sarcomatoid Urothelial Carcinoma Is Associated With Limited Response to Neoadjuvant Chemotherapy and Poor Oncologic Outcomes After Radical Cystectomy. Clin Genitourin Cancer 2023; 21:507.e1-507.e14. [PMID: 37150667 PMCID: PMC10621753 DOI: 10.1016/j.clgc.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION To examine oncologic outcomes and response to neoadjuvant chemotherapy (NAC) in patients with sarcomatoid urothelial carcinoma (SUC) treated with radical cystectomy (RC). MATERIALS AND METHODS We retrospectively queried our institutional database (2003-18) and Surveillance, Epidemiology, and End Results (SEER)-Medicare (2004-2015) for patients with cT2-4, N0-2, M0 SUC and conventional UC (CUC) treated with RC. Clinicopathologic characteristics were described using descriptive statistics (t test, χ2-test and log-rank-test for group comparison). Overall (OS) and recurrence-free-survival (RFS) after RC were estimated with the Kaplan Meier method and associations with OS were evaluated with Cox proportional hazards models. RESULTS We identified 38 patients with SUC and 287 patients with CUC in our database, and 190 patients with SUC in SEER-Medicare. In the institutional cohort, patients with SUC versus CUC had higher rates of pT3/4 stage (66% vs. 35%, P < 0.001), lower rates of ypT0N0 (6% vs. 35%, P = .02), and worse median OS (17.5 vs. 120 months, P < .001). Further, patients with SUC in the institutional versus SEER-Medicare cohort had similar median OS (17.5 vs. 21 months). In both cohorts, OS was comparable between patients with SUC undergoing NAC+RC vs. RC alone (17.5 vs. 18.4 months, P = .98, institutional cohort; 24 vs. 20 months, P = .56, SEER cohort). In Cox proportional hazards models for the institutional RC cohort, SUC was independently associated with worse OS (HR 2.3, CI 1.4-3.8, P = .001). CONCLUSION SUC demonstrates poor pathologic response to NAC and worse OS compared with CUC, with no OS benefit associated with NAC. A unique pattern of rapid abdominopelvic cystic recurrence was identified.
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Affiliation(s)
- Rishi R Sekar
- Department of Urology, University of Michigan, Ann Arbor, MI.
| | | | - Dimitra R Bakaloudi
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Ali R Khaki
- Division of Oncology, Department of Medicine, Stanford University, Palo Alto, CA
| | - Petros Grivas
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Brian R Winters
- Department of Urology, Kaiser Permanente Washington, Bellevue, Washington
| | - Funda Vakar-Lopez
- Department of Pathology, University of Washington School of Medicine, Seattle, WA
| | - Maria S Tretiakova
- Department of Pathology, University of Washington School of Medicine, Seattle, WA
| | - Sarah P Psutka
- Fred Hutchinson Cancer Center, Seattle, WA; Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Sarah K Holt
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - John L Gore
- Fred Hutchinson Cancer Center, Seattle, WA; Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Daniel W Lin
- Fred Hutchinson Cancer Center, Seattle, WA; Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - George R Schade
- Fred Hutchinson Cancer Center, Seattle, WA; Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Andrew C Hsieh
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - John K Lee
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Todd Yezefski
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Michael T Schweizer
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Heather H Cheng
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Evan Y Yu
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Lawrence D True
- Department of Pathology, University of Washington School of Medicine, Seattle, WA
| | - R Bruce Montgomery
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Jonathan L Wright
- Fred Hutchinson Cancer Center, Seattle, WA; Department of Urology, University of Washington School of Medicine, Seattle, WA
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Kitamura K, Isotani S, Muto S, Horie S. Efficacy of pembrolizumab in a rare type of bladder cancer arising 25 years after augmentation cystoplasty. BMJ Case Rep 2022; 15:e244719. [PMID: 35354571 PMCID: PMC8968561 DOI: 10.1136/bcr-2021-244719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2022] [Indexed: 11/04/2022] Open
Abstract
We report using the checkpoint inhibitor, pembrolizumab, as part of a multimodal treatment plan in a 36-year-old man with a rare bladder cancer arising 25 years after augmentation cystoplasty (sigmoid colonic cystectomy for neuropathic bladder was performed at 9 years old). On a regular clinic visit for clean intermittent catheterisation, the patient presented with gross haematuria and was diagnosed with urothelial carcinoma with sarcomatoid change. Gemcitabine and cisplatin-based neoadjuvant chemotherapy was unsuccessful, and pembrolizumab infusions (200 mg every 3 weeks) were initiated. A partial response was confirmed after six courses of pembrolizumab, with significant tumour shrinkage. A radical cystoprostatectomy and ileal conduit construction was performed, and pathology revealed no evidence of malignancy (ypT0, N0). The patient was successfully treated with the anti-programmed death-1 inhibitor, pembrolizumab, which was curative after total cystectomy. Further research is required to elucidate the potential role of checkpoint inhibitors in bladder cancers arising after augmentation cystoplasty.
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Affiliation(s)
- Kosuke Kitamura
- Urology, Juntendo University, Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Urology, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan
| | - Shuji Isotani
- Urology, Juntendo University, Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Satoru Muto
- Urology, Juntendo University, Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Shigeo Horie
- Urology, Juntendo University, Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
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de Jong JJ, Narayan VM, Cronican AA, Gupta S, van Leenders GJLH, Boormans JL, Gibb EA, Konety BR. Gene Expression Profiling of Muscle-Invasive Bladder Cancer With Secondary Variant Histology. Am J Clin Pathol 2021; 156:895-905. [PMID: 34157072 DOI: 10.1093/ajcp/aqab047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To determine the potential impact of the presence of secondary variant histology on the gene expression profiles of muscle-invasive bladder cancer (MIBC) tumors. METHODS For six tumors, revised samples were collected from urothelial and secondary variant components (cohort A). The commercial cohort (cohort B) consisted of the anonymized gene expression profiles of 173 patients with MIBC. Samples were obtained from the clinical use of the Decipher Bladder test that were available as part of the Decipher GRID prospective registry (NCT02609269). Secondary variant presence in cohort B was abstracted from institutional pathology reports. For the commercial cohort, only the urothelial carcinoma component was profiled. RESULTS Molecular subtyping of both urothelial and variant components found micropapillary and nested cases were classified as a luminal subtype. Conversely, the sarcomatoid and small cell cases were classified as basal/squamous or neuroendocrine-like, respectively. For cohort B, 50 (29%) of 173 cases had reported secondary variant histology. Cases with squamous variant had basal profiles, small cell cases expressed neuronal markers, and micropapillary cases were classified as luminal. Sarcomatoid tumors had robust epithelial-mesenchymal transition marker expression. CONCLUSIONS Our data suggest that in MIBC with secondary variant, the urothelial component can demonstrate an expression profile that closely resembles the variant component.
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Affiliation(s)
- Joep J de Jong
- Department of Urology, Erasmus MC, Cancer Institute Rotterdam,The Netherlands
| | - Vikram M Narayan
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Shilpa Gupta
- Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN, USA
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH
| | | | - Joost L Boormans
- Department of Urology, Erasmus MC, Cancer Institute Rotterdam,The Netherlands
| | | | - Badrinath R Konety
- Department of Urology, Erasmus MC, Cancer Institute Rotterdam,The Netherlands
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Abstract
PURPOSE OF REVIEW Molecular characterization of cancer allows us to understand oncogenesis and clinical prognosis as well as facilitates development of biomarkers and treatment. Our aim was to review the current literature on genomic characterization of bladder cancer, and how far we are in implementing genomics into clinical practice. RECENT FINDINGS Bladder cancers are molecularly diverse tumors with a high mutational rate. On molecular level, bladder cancer can be categorized into at least six subtypes called luminal-papillary, luminal-unstable, luminal non-specified, basal-squamous, neuroendocrine-like, and stroma-rich. These subtypes have characteristic genomic and transcriptomic profiles and appear to have different prognoses. Several molecular subtypes have been identified in bladder cancer. Prospective trials are underway to validate the applicability of genomic subtypes for clinical decision making. Further integrative analyses of genomic alterations, gene expression, epigenetics, and proteomics need to be performed before genomic subtyping can be attained in clinical practice.
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Affiliation(s)
- Tuomas Jalanko
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, Canada.,Department of Urology, Helsinki University, Helsinki, Finland
| | - Joep J de Jong
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Roland Seiler
- Department of Urology, University of Bern, Bern, Switzerland
| | - Peter C Black
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, Canada.
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