Abstract
Objective
To determine if the timing of radical cystectomy for variant histology of urothelial
carcinoma has an impact on survival. Variant histology has been associated with aberrant
behavior compared to pure urothelial carcinoma, however the timing of surgery for
these patients has not been studied.
Materials and Methods
We identified 363 patients with cT2-T4N0M0 urothelial carcinoma who underwent radical
cystectomy without perioperative intravesical and/or systemic therapy from 2003 to
2014. Clinicopathologic data were compared between pure urothelial carcinoma and variant
histology. The time from diagnosis to radical cystectomy was analyzed as a continuous
variable and dichotomized at 4-, 8-, and 12-weeks to determine impact on oncologic
outcomes.
Results
Patients with variant histology, when compared to those with pure urothelial carcinoma,
were more likely to present with extravesical disease (P <.01), be upstaged (P <.01), have lymphovascular invasion (P <.01) and have lymph node metastasis at radical cystectomy (P = .02). The median days to radical cystectomy did not differ between pure urothelial
and variant histology. On multivariable analysis controlling for age, comorbidities,
tumor stage, lymph node status, lymphovascular invasion, and surgical margins, every
month in delay was associated with a worse overall survival for variants (HR = 1.36,
P = .003). At an 8-week delay or longer, those with variant histology had a statistically
worse survival (P = .03).
Conclusion
For patients with variant histology, delays in surgery were associated with an increased
risk of death.
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Article info
Publication history
Published online: August 14, 2019
Accepted:
July 11,
2019
Received:
April 26,
2019
Footnotes
Financial Disclosures: Nothing to disclose.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
