PQA 06 - Genitourinary Cancer, Gynecological Cancer, and Health Care Access and Engagement
Presenter(s)
A. Cabal1, S. Sugumaran2, M. R. Folkert3, J. Chen4, W. Vuong5, J. Takayesu3, M. Schweizer1, R. Nadal6, R. Raychaudhuri7, H. Khan7, T. Yezefski1, E. Y. Yu8, B. Montgomery2, P. Grivas1, E. S. Weg9, J. Zeng10, J. J. Liao11, O. Y. Mian10, and T. M. M. Ma12; 1University of Washington, Seattle, WA, 2University of Washington, Seattle, WA, United States, 3Department of Radiation Oncology, University of Washington, Seattle, WA, 4Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA, 5Cleveland Clinic Foundation, Cleveland, OH, 6Fred Hutchinson Cancer Center, Seattle, WA, 7Division of Hematology and Oncology, University of Washington/Fred Hutchinson Cancer Center, Seattle, WA, 8Seattle Cancer Care Alliance, Seattle, WA, 9Weill Cornell Medical College, New York, NY, 10Department of Radiation Oncology, University of Washington/Fred Hutchinson Cancer Center, Seattle, WA, 11University of Washington Fred Hutchinson Cancer Center, Seattle, WA, 12University of Washington, Department of Radiation Oncology, Seattle, WA
Purpose/Objective(s):
Trimodality therapy (TMT) offers bladder preservation for select patients with muscle-invasive bladder cancer (MIBC). Data on TMT efficacy in histologic subtypes/variants of urothelial carcinoma (VUC) remain limited. We compared outcomes between pure conventional urothelial carcinoma (PUC) and VUC following definitive TMT.
Materials/Methods:
This retrospective analysis included patients with cT2-4N0-2M0 MIBC treated with curative-intent TMT at a single academic center (2009-2025). Patient is classified as having VUC if any non-urothelial component is present. Kaplan-Meier methods were used to assess survival endpoints. Categorical variables were compared using chi-square or Fisher's exact tests.
Results:
Of 141 patients treated with TMT, 102 (72%) were male; 131 (93%) were White; 79 (56%) had PUC and 62 (44%) had VUC. Overall, 111 (79%), 19 (13%), 5 (4%) and 6 (4%) patients had cT2N0, cT3N0, cT4N0 and cT1-4N1-2 disease, respectively. Among patients with VUC, 37 (60%) had squamous and/or glandular differentiation, 11 (18%) had a micropapillary component, 8 (13%) had a neuroendocrine/small cell component and 4 (6%) had a sarcomatoid component. Median follow up was 20 months for both PUC and VUC cohorts. Among the PUC cohort , 66 (84%) received concurrent chemotherapy with radiation therapy, compared to 51 (82%) in patients with VUC. There was no significant difference in the presence of carcinoma in situ (PUC vs. VUC, 25% vs. 34%, p=0.27), or rate of any hydronephrosis (22% vs. 21%, p=0.94). Patients with VUC were more likely to receive neoadjuvant chemotherapy than PUC patients (16% vs. 4%, p=0.017). Two-year outcomes showed no significant differences: MIBC local recurrence-free survival (62.5% PUC vs 66.4% VUC, p=0.22), pelvic regional recurrence-free survival (58.4% vs 64.6%, p=0.31), distant metastasis-free survival (57.3% vs 58.7%, p=0.35), bladder cancer-specific survival (81.8% vs 76.2%, p=0.90), and overall survival (72.4% vs 68.2%, p=0.63). Salvage cystectomy rates were low and similar between groups (7.6% PUC vs 1.6% VUC, p=0.13).
Conclusion:
Patients with VUC appeared to have similar oncologic outcomes with those with PUC after TMT. Limitations include the retrospective design, moderate sample size, single academic center, heterogeneity of histology subtypes, selection and confounding biases. Our hypothesis-generating findings suggest that VUC alone may not exclude patients from bladder-sparing therapy consideration.
