Implications of micropapillary urothelial carcinoma variant on prognosis following radical cystectomy: A multi-institutional investigation

Anirban P. Mitra, Adrian S. Fairey, Eila C. Skinner, Stephen A. Boorjian, Igor Frank, Mark P. Schoenberg, Trinity J. Bivalacqua, M. Eric Hyndman, Adam C. Reese, Gary D. Steinberg, Michael C. Large, Christina A. Hulsbergen-van de Kaa, Harman M. Bruins, Siamak Daneshmand

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Purpose: To determine the association of micropapillary urothelial carcinoma (MUC) variant histology with bladder cancer outcomes after radical cystectomy. Materials and Methods: Information on MUC patients treated with radical cystectomy was obtained from five academic centers. Data on 1,497 patients were assembled in a relational database. Tumor histology was categorized as urothelial carcinoma without any histological variants (UC; n = 1,346) or MUC (n = 151). Univariable and multivariable models were used to analyze associations with recurrence-free (RFS) and overall (OS) survival. Results: Median follow-up was 10.0 and 7.8 years for the UC and MUC groups, respectively. No significant differences were noted between UC and MUC groups with regard to age, gender, clinical disease stage, and administration of neoadjuvant and adjuvant chemotherapy (all, P ≥ 0.10). When compared with UC, presence of MUC was associated with higher pathologic stage (organ-confined, 60% vs. 27%; extravesical, 18% vs. 23%; node-positive, 22% vs. 50%; P < 0.01) and lymphovascular invasion (29% vs. 58%; P < 0.01) at cystectomy. In comparison with UC, MUC patients had poorer 5-year RFS (70% vs. 44%; P < 0.01) and OS (61% vs. 38%; P < 0.01). However, on multivariable analysis, tumor histology was not independently associated with the risks of recurrence (P = 0.27) or mortality (P = 0.12). Conclusions: This multi-institutional analysis demonstrated that the presence of MUC was associated with locally advanced disease at radical cystectomy. However, clinical outcomes were comparable to those with pure UC after controlling for standard clinicopathologic predictors.

Original languageEnglish (US)
JournalUrologic Oncology: Seminars and Original Investigations
DOIs
StateAccepted/In press - Jan 1 2018

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Cystectomy
Carcinoma
Histology
Recurrence
Adjuvant Chemotherapy
Urinary Bladder Neoplasms
Neoplasms
Databases
Survival
Mortality

Keywords

  • Cystectomy
  • Micropapillary urothelial carcinoma
  • Outcomes
  • Urinary bladder neoplasms

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Implications of micropapillary urothelial carcinoma variant on prognosis following radical cystectomy : A multi-institutional investigation. / Mitra, Anirban P.; Fairey, Adrian S.; Skinner, Eila C.; Boorjian, Stephen A.; Frank, Igor; Schoenberg, Mark P.; Bivalacqua, Trinity J.; Hyndman, M. Eric; Reese, Adam C.; Steinberg, Gary D.; Large, Michael C.; Hulsbergen-van de Kaa, Christina A.; Bruins, Harman M.; Daneshmand, Siamak.

In: Urologic Oncology: Seminars and Original Investigations, 01.01.2018.

Research output: Contribution to journalArticle

Mitra, AP, Fairey, AS, Skinner, EC, Boorjian, SA, Frank, I, Schoenberg, MP, Bivalacqua, TJ, Hyndman, ME, Reese, AC, Steinberg, GD, Large, MC, Hulsbergen-van de Kaa, CA, Bruins, HM & Daneshmand, S 2018, 'Implications of micropapillary urothelial carcinoma variant on prognosis following radical cystectomy: A multi-institutional investigation', Urologic Oncology: Seminars and Original Investigations. https://doi.org/10.1016/j.urolonc.2018.10.013
Mitra, Anirban P. ; Fairey, Adrian S. ; Skinner, Eila C. ; Boorjian, Stephen A. ; Frank, Igor ; Schoenberg, Mark P. ; Bivalacqua, Trinity J. ; Hyndman, M. Eric ; Reese, Adam C. ; Steinberg, Gary D. ; Large, Michael C. ; Hulsbergen-van de Kaa, Christina A. ; Bruins, Harman M. ; Daneshmand, Siamak. / Implications of micropapillary urothelial carcinoma variant on prognosis following radical cystectomy : A multi-institutional investigation. In: Urologic Oncology: Seminars and Original Investigations. 2018.
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abstract = "Purpose: To determine the association of micropapillary urothelial carcinoma (MUC) variant histology with bladder cancer outcomes after radical cystectomy. Materials and Methods: Information on MUC patients treated with radical cystectomy was obtained from five academic centers. Data on 1,497 patients were assembled in a relational database. Tumor histology was categorized as urothelial carcinoma without any histological variants (UC; n = 1,346) or MUC (n = 151). Univariable and multivariable models were used to analyze associations with recurrence-free (RFS) and overall (OS) survival. Results: Median follow-up was 10.0 and 7.8 years for the UC and MUC groups, respectively. No significant differences were noted between UC and MUC groups with regard to age, gender, clinical disease stage, and administration of neoadjuvant and adjuvant chemotherapy (all, P ≥ 0.10). When compared with UC, presence of MUC was associated with higher pathologic stage (organ-confined, 60{\%} vs. 27{\%}; extravesical, 18{\%} vs. 23{\%}; node-positive, 22{\%} vs. 50{\%}; P < 0.01) and lymphovascular invasion (29{\%} vs. 58{\%}; P < 0.01) at cystectomy. In comparison with UC, MUC patients had poorer 5-year RFS (70{\%} vs. 44{\%}; P < 0.01) and OS (61{\%} vs. 38{\%}; P < 0.01). However, on multivariable analysis, tumor histology was not independently associated with the risks of recurrence (P = 0.27) or mortality (P = 0.12). Conclusions: This multi-institutional analysis demonstrated that the presence of MUC was associated with locally advanced disease at radical cystectomy. However, clinical outcomes were comparable to those with pure UC after controlling for standard clinicopathologic predictors.",
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T2 - A multi-institutional investigation

AU - Mitra, Anirban P.

AU - Fairey, Adrian S.

AU - Skinner, Eila C.

AU - Boorjian, Stephen A.

AU - Frank, Igor

AU - Schoenberg, Mark P.

AU - Bivalacqua, Trinity J.

AU - Hyndman, M. Eric

AU - Reese, Adam C.

AU - Steinberg, Gary D.

AU - Large, Michael C.

AU - Hulsbergen-van de Kaa, Christina A.

AU - Bruins, Harman M.

AU - Daneshmand, Siamak

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N2 - Purpose: To determine the association of micropapillary urothelial carcinoma (MUC) variant histology with bladder cancer outcomes after radical cystectomy. Materials and Methods: Information on MUC patients treated with radical cystectomy was obtained from five academic centers. Data on 1,497 patients were assembled in a relational database. Tumor histology was categorized as urothelial carcinoma without any histological variants (UC; n = 1,346) or MUC (n = 151). Univariable and multivariable models were used to analyze associations with recurrence-free (RFS) and overall (OS) survival. Results: Median follow-up was 10.0 and 7.8 years for the UC and MUC groups, respectively. No significant differences were noted between UC and MUC groups with regard to age, gender, clinical disease stage, and administration of neoadjuvant and adjuvant chemotherapy (all, P ≥ 0.10). When compared with UC, presence of MUC was associated with higher pathologic stage (organ-confined, 60% vs. 27%; extravesical, 18% vs. 23%; node-positive, 22% vs. 50%; P < 0.01) and lymphovascular invasion (29% vs. 58%; P < 0.01) at cystectomy. In comparison with UC, MUC patients had poorer 5-year RFS (70% vs. 44%; P < 0.01) and OS (61% vs. 38%; P < 0.01). However, on multivariable analysis, tumor histology was not independently associated with the risks of recurrence (P = 0.27) or mortality (P = 0.12). Conclusions: This multi-institutional analysis demonstrated that the presence of MUC was associated with locally advanced disease at radical cystectomy. However, clinical outcomes were comparable to those with pure UC after controlling for standard clinicopathologic predictors.

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KW - Cystectomy

KW - Micropapillary urothelial carcinoma

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KW - Urinary bladder neoplasms

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