Delayed radical cystectomy (RC) for patients with variant histology urothelial carcinoma (UC) of the bladder increases the risk of death, according to investigators.
In a study comparing variant histology UC and pure UC, each 1-month delay in RC from the time of diagnosis was significantly associated with a 36% increased risk of death on multivariate analysis controlling for age, tumor stage, node status, and other variables, a team from the University of Southern California in Los Angeles led by Siamak Daneshmand, MD, reported in Urology. In addition, a delay of more than 12 weeks for RC from diagnosis was significantly associated with an almost 3.5-fold increased risk of death compared with RC performed 12 weeks or less after diagnosis.
Dr Daneshmand and his colleagues noted that pathologic variants had a propensity to present with more advanced disease compared with pure UC. This aggressive growth pattern may explain why patients with variant histology are more susceptible to delay-related adverse outcomes compared with those who have pure UC, according to the investigators.
The study included 68 patients with variant histology and 295 with pure UC. Patients had median ages of 74 and 73 years, respectively, and a median follow-up time of 42.4 months.
The variant histology group was more likely than the pure UC group to have a higher clinical stage (cT3-4, 16.2% vs 7.8%) and pathologic stage (58.8% vs 30.2% for T3 and 13.2% vs 6.8% for T4 disease) and to be upstaged at RC (60.3% vs 31.2%). The variant histology and pure UC groups did not differ significantly in the median time to RC: 56 vs 55 days.
Lin-Brande M, Pearce SM, Ashrafi AN, et al. Assessing the impact of time to cystectomy for variant histology of urothelial bladder cancer. Urology. 2019.