부산대학교 도서관

Bacillus Calmette-Guerin (BCG) has been the gold-standard intravesical agent for the management of intermediate and high-risk non-muscle invasive bladder cancer (NMIBC). However, the presence of variant histology (VH) in NMIBC patients is considered an especially high-risk feature for which up-front radical cystectomy (RC) should be offered. Limited data exists on oncologic outcomes in NMIBC patients with VH who are managed with intravesical therapy. Therefore, the goal of the present study was to examine oncologic outcomes for NMIBC with VH managed with intravesical therapy at a high-volume tertiary care center. A retrospective review of an IRB-approved bladder cancer database was performed. Patients with a history of NMIBC with VH present on transurethral resection of bladder tumor (TURBT) treated with either BCG or chemotherapy were identified. Patients were required to have underwent both initial and a restaging TURBT and had re-review of pathology specimens by a fellowship-trained genitourinary pathologist. If multiple variants were present, the variant to have the highest percentage present in the specimen was recorded. The primary outcome was recurrence within the bladder (bladder RFS), which was defined as any evidence of recurrence on cystoscopy that was confirmed on TURBT. Other endpoints included progression to muscle invasive disease (MIBC RFS) and metastasis free survival (MFS). Survival time was defined from date of initiation of intravesical therapy to date of event or censoring. The Kaplan-Meier method with log rank was used to estimate oncologic outcomes among the various VH sub-populations. Ninety patients were included for the final analysis with a median follow-up of 38 months. The following VHs were included: glandular (26%), squamous differentiation (26%), giant cell (15%), micropapillary (13%), nested (9%), plasmacytoid (7%), sarcomatoid (2%), and lymphoepithelioma-like (2%). The majority of patients had T1 disease (72%) and received BCG (83%). At 5 years, 48 patients (53%) had experienced a recurrence with a median RFS of 24 months (95% Confidence Interval: 2-46 months). Five-year rates of progression to MIBC or metastasis were low at 14%. When stratifying by VH, patients with sarcomatoid or plasmacytoid had significantly worse oncologic outcomes, which is consistent with prior literature. Twenty-six patients (29%) proceeded to radical cystectomy with cystectomy free survival of 14 months (95% CI: 7-24 months). In a series of highly selected patients with NMBIC and VH, bladder-sparing treatment with intravesical therapy demonstrated acceptable oncologic outcomes for most VH. Therefore, through shared medical decision making, this may be a possible treatment alternative for NMIBC patients who are not suitable cystectomy candidates or who would prefer to pursue bladder-sparing treatment. [ABSTRACT FROM AUTHOR]