Contemporary treatment patterns and outcomes of sarcomatoid bladder cancer.
OBJECTIVE
To characterize the treatment patterns and survival outcomes of sarcomatoid bladder cancer, a rare urothelial variant histology using a large population level cancer database.


METHODS
The National Cancer Database was queried for all cases of sarcomatoid bladder cancer using International Classification of Disease-O-3 morphologic code 8122 between 2004 and 2014. Primary outcome was overall survival.


RESULTS
A total of 489 patients met our inclusion criteria and were included in our analysis. Average age at diagnosis was 70.4 years. The majority of the population was male (61.8%) and Caucasian (92.2%). Tumor characteristics included 23.7% cT1, 41.1% cT2 and 15.3% cT3 or above. Median overall survival was 18.4 months (95% CI 13.3-23.6). On multivariate Cox proportional analysis, radical cystectomy alone or with multimodal therapy (chemotherapy or radiotherapy) resulted in a statistically significant reduction in the risk of death as compared to bladder preservation surgery alone. Survival in the radical cystectomy group did not differ between radical cystectomy alone and those receiving either neoadjuvant or adjuvant chemotherapy.


CONCLUSIONS
Sarcomatoid bladder cancer has poor prognosis with 18.4-month median overall survival. While our data suggest that aggressive treatment improves outcomes, the role of multimodal therapy is unclear. Future study should continue to focus on multi-institutional collaboration to determine the most effective therapy.
Department of Urology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington, 11th Floor, New York, NY, 10032, USA. ws2375@columbia.edu.
Wilson
http://orcid.org/0000-0002-1819-6596
W
Sui
Department of Urology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington, 11th Floor, New York, NY, 10032, USA.
Justin T
JT
Matulay
Department of Urology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington, 11th Floor, New York, NY, 10032, USA.
Ifeanyi C
IC
Onyeji
Department of Urology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington, 11th Floor, New York, NY, 10032, USA.
Marissa C
MC
Theofanides
Department of Urology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington, 11th Floor, New York, NY, 10032, USA.
Maxwell B
MB
James
Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA.
Arindam
A
RoyChoudhury
Department of Urology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington, 11th Floor, New York, NY, 10032, USA.
Sven
S
Wenske
Department of Urology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington, 11th Floor, New York, NY, 10032, USA.
G Joel
GJ
DeCastro
D000368:Aged; D002296:Carcinosarcoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D017024:Chemotherapy, Adjuvant / Q000379:methods / Q000706:statistics & numerical data; D003131:Combined Modality Therapy; D015653:Cystectomy / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009367:Neoplasm Staging; D010043:Outcome and Process Assessment, Health Care; D011878:Radiotherapy / Q000379:methods / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy
Bladder; Bladder neoplasms; Survival