Abstract
Background
Micropapillary urothelial carcinoma (MPC) is a rare urothelial carcinoma variant with
conflicting data guiding clinical practice. In this study, we explored oncologic outcomes
in relation to neoadjuvant chemotherapy (NAC) in a retrospective cohort of patients
with MPC, alongside data from Surveillance, Epidemiology, and End Results (SEER)-Medicare.
Patients and Methods
We retrospectively identified patients with MPC or conventional urothelial carcinoma
(CUC) without any variant histology undergoing radical cystectomy (RC) in our institution
(2003-2018). SEER-Medicare was also queried to identify patients diagnosed with MPC
(2004-2015). Clinicopathologic data and treatment modalities were extracted. Overall
survival (OS) was estimated with the Kaplan-Meier method. Mann-Whitney-Wilcoxon and
chi-square tests were used for comparative analysis and Cox regression for identifying
clinical covariates associated with OS.
Results
Our institutional database yielded 46 patients with MPC and 457 with CUC. In SEER-Medicare,
183 patients with MPC were identified, and 63 (34%) underwent RC. In the institutional
cohort, patients with MPC had significantly higher incidence of cN+ (17% vs. 8%),
pN+ stage (30% vs. 17%), carcinoma-in-situ (43% vs. 25%), and lymphovascular invasion
(30% vs. 16%) at RC versus those with CUC (all P < .05). Pathologic complete response (ypT0N0) to NAC was 33% for MPC and 35% for
CUC (P = .899). Median OS was lower for institutional MPC versus CUC in univariate analysis
(43.6 vs. 105.3 months, P = .006); however, MPC was not independently associated with OS in the multivariate
model. Median OS was 25 months in the SEER MPC cohort for patients undergoing RC,
while NAC was not associated with improved OS in that group.
Conclusion
Pathologic response to NAC was not significantly different between MPC and CUC, while
MPC histology was not an independent predictor of OS. Further studies are needed to
better understand biological mechanisms behind its aggressive features as well as
the role of NAC in this histology variant.
Keywords
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Article Info
Publication History
Published online: October 14, 2020
Accepted:
October 4,
2020
Received in revised form:
October 1,
2020
Received:
April 21,
2020
Identification
Copyright
Published by Elsevier Inc.
