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Radical cystectomy in non-metastatic sarcomatoid bladder cancer: A direct comparison vs urothelial bladder cancer

  • Stefano Tappero
    Correspondence
    Corresponding author. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
    Affiliations
    Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada

    Department of Urology, IRCCS Policlinico San Martino, Genova, Italy

    Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
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  • Andrea Panunzio
    Affiliations
    Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada

    Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Italy
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  • Lukas Hohenhorst
    Affiliations
    Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada

    Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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  • Cristina Cano Garcia
    Affiliations
    Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada

    Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Frankfurt Am Main, Germany
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  • Francesco Barletta
    Affiliations
    Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada

    Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
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  • Mattia Piccinelli
    Affiliations
    Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada

    Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
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  • Zhe Tian
    Affiliations
    Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
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  • Stefano Parodi
    Affiliations
    Department of Urology, IRCCS Policlinico San Martino, Genova, Italy

    Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
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  • Alessandro Antonelli
    Affiliations
    Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Italy
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  • Markus Graefen
    Affiliations
    Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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  • Felix K.H. Chun
    Affiliations
    Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Frankfurt Am Main, Germany
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  • Alberto Briganti
    Affiliations
    Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
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  • Ottavio De Cobelli
    Affiliations
    Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
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  • Fred Saad
    Affiliations
    Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
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  • Shahrokh F. Shariat
    Affiliations
    Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria

    Department of Urology, Weill Cornell Medical College, New York, NY, USA

    Department of Urology, University of Texas Southwestern, Dallas, TX, USA

    Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
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  • Nazareno Suardi
    Affiliations
    Department of Urology, Spedali Civili of Brescia, Brescia, Italy
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  • Marco Borghesi
    Affiliations
    Department of Urology, IRCCS Policlinico San Martino, Genova, Italy

    Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
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  • Carlo Terrone
    Affiliations
    Department of Urology, IRCCS Policlinico San Martino, Genova, Italy

    Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
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  • Pierre I. Karakiewicz
    Affiliations
    Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
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Published:September 23, 2022DOI:https://doi.org/10.1016/j.ejso.2022.09.013

      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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