Differences in cancer-specific mortality after trimodal therapy for T2N0M0 bladder cancer according to histological subtype

Abstract

Simple Summary Trimodal therapy represents an accepted treatment option for non-metastatic muscle-invasive bladder cancer, which is an alternative to radical cystectomy. Evidence regarding trimodal therapy efficacy has predominantly, or even exclusively, been applied to urothelial carcinoma of the urinary bladder patients. To address this void, we tested for differences in cancer-specific mortality in trimodal therapy-treated bladder cancer patients, according to histological subtype, namely urothelial carcinoma vs. neuroendocrine carcinoma vs. squamous cell carcinoma vs. adenocarcinoma. We aimed at assessing the impact of non-urothelial variant histology (VH), relative to urothelial carcinoma of the urinary bladder (UCUB), on cancer-specific mortality (CSM) in T2N0M0 bladder cancer patients treated with trimodal therapy (TMT). TMT patients treated for T2N0M0 bladder cancer were identified within the Surveillance, Epidemiology, and End Results database (2000-2018). Patients who underwent TMT received trans-urethral resection of the bladder tumor, chemotherapy, and radiotherapy. CSM-FS rates were tested using Kaplan-Meier plots and multivariable Cox-regression (MCR) models according to histological subtype: UCUB vs. neuroendocrine carcinoma vs. squamous cell carcinoma vs. adenocarcinoma. A total of 3846 T2N0MO bladder cancer patients treated with TMT were identified. Of these, 3627 (94.3%) harbored UCUB, while 105 (2.7%), 85 (2.2%), and 29 (0.8%) harbored neuroendocrine carcinoma, squamous cell carcinoma, and adenocarcinoma, respectively. In Kaplan-Meier analyses, 3-yr CSM-FS rates were 57% for UCUB, 51% for neuroendocrine carcinoma, 35% for squamous cell carcinoma, and 60% for adenocarcinoma (p-value < 0.0001). In MCR models, only squamous cell carcinoma exhibited higher CSM than UCUB (HR 1.98, 95%CI 1.5-2.61, p-value < 0.001). Despite the small number of observations, squamous cell carcinoma distinguished itself from UCUB based on worse survival in T2N0M0 patients after TMT.