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JU INSIGHT Long-Term Oncological Outcomes in Patients With Nonmetastatic Plasmacytoid Variant of Bladder Cancer
By: Akshay Sood, MD, The University of Texas MD Anderson Cancer Center, Houston, The Ohio State University Wexner Medical Center, Columbus; Jan K. Rudzinski, MD, MSc, The University of Texas MD Anderson Cancer Center, Houston; Craig V. Labbate, MD, The University of Texas MD Anderson Cancer Center, Houston; Patrick J. Hensley, MD, The University of Texas MD Anderson Cancer Center, Houston; Kelly K. Bree, MD, The University of Texas MD Anderson Cancer Center, Houston; Charles C. Guo, MD; The University of Texas MD Anderson Cancer Center, Houston; Omar Alhalabi, MD, The University of Texas MD Anderson Cancer Center, Houston; Matthew T. Campbell, MD, The University of Texas MD Anderson Cancer Center, Houston; Arlene O. Siefker-Radtke, MD, The University of Texas MD Anderson Cancer Center, Houston; Neema Navai, MD, The University of Texas MD Anderson Cancer Center, Houston; Colin P.N. Dinney, MD, The University of Texas MD Anderson Cancer Center, Houston; Jianjun Gao, MD, PhD*, The University of Texas MD Anderson Cancer Center, Houston; Ashish M. Kamat, MD*, The University of Texas MD Anderson Cancer Center, Houston * Co-senior authors. | Posted on: 21 Feb 2024
Sood A, Rudzinski JK, Labbate CV, et al. Long-term oncological outcomes in patients diagnosed with nonmetastatic plasmacytoid variant of bladder cancer: a 20-year University of Texas MD Anderson Cancer Center experience. J Urol. 2024;211(2):241-255.
Study Need and Importance
The plasmacytoid variant of bladder cancer (PV-BCa) is a rare and lethal malignancy. We sought to examine the treatment patterns and recurrence and survival outcomes in patients with nonmetastatic PV-BCa at presentation in order to identify opportunities for improving outcomes.
What We Found
In 56 consecutive nonmetastatic PV-BCa patients who were treated with curative intent at our institution between 1998 and 2018, the stage at presentation was: ≤ cT2N0 in 22 (39.3%), cT3N0 in 15 (26.8%), cT4N0 in 13 (23.2%), and ≥ cN1 in 6 patients (10.7%). Forty-nine patients (87.5%) received chemotherapy and 42 (75%) were able to undergo the planned surgery. Notably, only 4 patients (7.2%) had pT0 stage, whilst 22 (52.4%) had pN+ disease at the time of surgery. At 36-month follow-up, only 28.4% of patients (95% CI: 22.1% to 34.5%) were alive and 22.2% (95% CI: 16.1% to 28.5%) free of metastatic disease. The median time to metastasis from primary treatment end was 6.5 months (IQR: 2.9 to 14.7). The predominant site of recurrence/metastasis was the peritoneum (76.1%), either in isolation or along with extraperitoneal lesions (Figure). Salvage immunotherapy in these patients significantly reduced the risk of cancer-associated death (HR = 0.11, P = .001), more so than salvage chemotherapy, with 28.6% of patients experiencing a durable response at a median follow-up of 4 years.
Limitations
Limitations were retrospective chart review and small sample size.
Interpretation for Patient Care
PV-BCa is a disease with high lethality. Despite multimodal treatment, a vast majority of patients develop atypical intraperitoneal metastasis soon after therapy and rapidly succumb to it. Clinical trials evaluating the utility of hyperthermic intraperitoneal chemotherapy and/or immunotherapy may be reasonable in this high-risk population.
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