Outcomes of Neoadjuvant Chemotherapy in Patients with Variant Histology After Robot-Assisted Radical Cystectomy
Results from the International Robotic Cystectomy Consortium
Abstract
Abstract
Introduction and Objective: We sought to describe the utilization and outcomes of neoadjuvant chemotherapy (NAC) among patients with variant histology who underwent robot-assisted radical cystectomy (RARC).
Methods: A retrospective review of the multi-institutional prospectively maintained International Robotic Cystectomy Consortium (IRCC) database was performed (4139 patients from 33 institutions in 12 countries). Patients with preoperative variant histology (whether pure variant or mixed with urothelial) were identified, and then grouped based on receipt of NAC. Descriptive statistics were used to summarize the data. Kaplan Meier method was used to depict recurrence-free (RFS), disease-specific (DSS), and overall survival (OS). Multivariate Cox regression models were used to depict variables associated with RFS, DSS, and OS.
Results: 278 patients had preoperative variant histology and 23% of these received NAC. Variant histology was absent in 43% of patients at RARC. There was no significant difference in terms of pT, pN, positive margins or recurrence rates between those who received NAC and those who did not (p>0.05 for all). Patients who received NAC had RFS of 84% and 76% at 1 and 3 years, respectively, compared to 74% and 59% for those who did not receive NAC, respectively (log rank p=0.12). Patients who received NAC had DSS of 85% and 81% at 1 and 3 years, respectively, compared to 89% and 72% for those who did not receive NAC, respectively (log rank p=0.96). Patients who received NAC had OS of 77% and 65% at 1 and 3 years, compared to 76% and 60% for those who did not receive NAC, respectively (log rank p=0.70). pN+ (HR 2.29, 95% CI 1.38–3.78, p=0.01) and pT3/T4 (HR 4.68, 95% CI 2.50–8.76, p<0.01) were associated with worse RFS. pN+ (HR 2.76, 95% CI 1.39–5.44, p<0.01) and pT3/T4 (HR 4.10, 95% CI 1.83–9.17, p=0.01) were associated with worse DSS. pN+ (HR: 2.58, 95% CI: 1.6 – 4.14, p<0.01) and pT3/T4 (HR 3.03, 95% CI 1.74–5.28, p<0.01) were associated with worse OS. Positive margins (HR 2.17, 95% CI 1.25– 3.77, p<0.01) and higher Charlson Comorbidity Index (HR 1.25, 95% CI 1.09–1.43, p< 0.01) were associated with worse OS.
Conclusion: Twenty-three percent of patients with preoperative variant histology received NAC. Of these, 43% had no variant histology after cystectomy. There was no significant difference in oncologic outcomes between patients with variant histology who received NAC and those who did not.
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