The following is a summary of “Oncologic outcomes of neoadjuvant chemotherapy in patients with micropapillary variant urothelial carcinoma of the bladder,” published in the February 2023 issue of “Urologic Oncology: Seminars and Original Investigations” by Rahman et al.

Patients with micropapillary variant urothelial carcinoma (MVUC) have a range of opinions on whether or not they should get neoadjuvant platinum-based chemotherapy before undergoing radical cystectomy. Comparing patients with micropapillary and non-variant bladder urothelial carcinoma (UC), researchers examined the correlation between neoadjuvant chemotherapy (NAC) and pathologic response (PR). During 2004-2017, researchers browsed the National Cancer Database for cases of localized UC and MVUC to identify patients. Patients who underwent radical cystectomy, with or without NAC, were the only ones considered for this study. For NAC, they compared clinical, demographic, and pathologic factors. 

They utilized multivariable logistic regression and propensity score matching to determine whether or not NAC is associated with a pathologic complete response (pT0) or lymph node positive (pN+). Overall survival (OS) was evaluated with Kaplan Meier and Cox proportional hazards models. Researchers analyzed the full dataset (cT2-T4) and subsets of patients with clinical stage II (cT2) illness. They found 18,761 individuals, of whom 18,027 had classic UC and 734 had MVUC. There was no significant difference between MVUC and non-variant UC in the correlation between NAC usage and pT0 (9.64[7.62-12.82], P<0.001). 

NAC usage was linked with lower odds of pN+ (OR 0.52 [0.26–0.92] P=0.047) and decreased risk of pathologic upstaging (OR 0.63 [0.34-0.97] P=0.042) and an increased risk of pT0 (OR 4.93 [2.43-13.18] P<0.001) in a propensity-matched analysis of individuals with MVUC. The results were the same for cT2 disease. NAC did not significantly affect survival with MVUC (HR 0.89 [0.46-1.10] P=0.63) or the subset of patients with cT2 (HR 0.83 [0.49-1.06] P=0.58). 

Patients with regional MVUC and non-variant UC have similar histologic and nodal responses to NAC. This retrospective hospital registry analysis found no correlation between improvements in pathologic findings and overall survival.

Source: sciencedirect.com/science/article/abs/pii/S1078143922003179