Impact of Divergent Differentiation and/or Histological Subtype of Urothelial Carcinoma on Patient Outcomes in the GETUG-AFU V05 VESPER Trial.
J Urol
; 211(4): 564-574, 2024 Apr.
Article
in En
| MEDLINE
| ID: mdl-38153961
ABSTRACT
PURPOSE:
Variant histology or divergent differentiation (VH/DD) of urothelial carcinoma (UC) may impact outcomes after neoadjuvant chemotherapy (NAC) in muscle-invasive bladder cancer. Our aim was to assess the pathological response and progression-free survival (PFS) of patients with VH/DD in the prospective VESPER clinical trial. MATERIALS ANDMETHODS:
This post hoc study included 300 NAC-treated patients with available transurethral diagnostic slides. Presence and percentage of VH/DDs were reviewed. For pathological response, logistic regression models were computed to measure association with VH/DD. For PFS, the associations were estimated in Cox proportional hazard regression model. All models were adjusted for randomization arm.RESULTS:
VH/DD was identified in 177/300 patients (59%) and was predominant (≥50%) in 85/177. Compared to pure UC, VH/DD (≥10% or ≥50%) was not associated with a difference in proportion of complete pathological response (ypT0N0; OR adjusted 0.79, 95% CI 0.49-1.29), downstaging (≤ypT1N0; OR adjusted 0.62, 95% CI 0.37-1.02), or with an increased hazard of PFS (HR adjusted 1.24, 95% CI 0.83-1.85). However, comparing specific VH/DD to pure UC, nested subtype was associated with decreased odds of complete pathological response (OR adjusted 0.33, 95% CI 0.12-0.88) and downstaging (OR adjusted 0.30, 95% CI 0.13-0.74), and an increased hazard of PFS was observed for UC with ≥ 50% squamous differentiation (HR adjusted 2.11, 95% CI 1.01-4.38) or micropapillary subtype (HR adjusted 2.03, 95% CI 0.98-4.22).CONCLUSIONS:
In the VESPER trial, we did not observe evidence for association of VH/DD with outcomes after NAC, but the specific presence of a predominant squamous differentiation or micropapillary subtype may be associated with shorter PFS.Key words
Full text:
1
Database:
MEDLINE
Main subject:
Urinary Bladder Neoplasms
/
Carcinoma, Squamous Cell
/
Carcinoma, Transitional Cell
Limits:
Humans
Language:
En
Journal:
J Urol
Year:
2024
Type:
Article
Affiliation country:
France