Abstract
Introduction
The effect of radical cystectomy (RC) on cancer-specific mortality (CSM) is unclear
in non-metastatic sarcomatoid bladder cancer (SBC) patients. We aimed to test the
benefit of RC in SBC, and to perform a direct comparison vs urothelial bladder cancer
(UCB).
Materials and methods
Within the Surveillance, Epidemiology, and End Results database (SEER 2001–2018) all
non-metastatic SBC and UBC patients were identified. Endpoint of interest was CSM.
Propensity score matching (PSM), cumulative incidence plots, competing risks regression
(CRR) analyses, three-months landmark analyses, and sensitivity analyses were performed.
All results were stratified according to organ-confined (OC: T2N0M0) vs non-organ-confined (NOC: T3-4N0M0 or TanyN1-3M0) stages.
Results
Of 554 SBC patients, 49 vs 51% harbored OC vs NOC stages. Of 47,741 UBC patients,
62 vs 38% harbored OC vs NOC stages. RC rates were 33 vs 67% in OC vs NOC-SBC patients,
and 40 vs 60% in OC vs NOC-UBC patients. After 1:1 PSM, comparison between RC vs no-RC
was performed in OC-SBC (67 patients per group), OC-UBC (7611 patients per group),
NOC-SBC (63 patients per group), and NOC-UBC patients (4644 patients per group). CRR
hazard ratios associated with RC vs no-RC were 0.37 (p < 0.001) in OC-SBC vs 0.45
(p < 0.001) in OC-UBC, and 0.56 (p = 0.01) in NOC-SBC vs 0.68 (p < 0.001) in NOC-UBC.
These results were replicated in sensitivity and landmark analyses.
Conclusions
The protective effect of RC vs no-RC is stronger in SBC than UBC patients, regardless
of OC vs NOC stages.
Keywords
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Article info
Publication history
Published online: September 23, 2022
Accepted:
September 20,
2022
Received in revised form:
August 18,
2022
Received:
July 11,
2022
Identification
Copyright
© 2022 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
