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Micropapillary Bladder Cancer: Insights from the National Cancer Database.

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Micropapillary bladder cancer (MPBC) has a poor prognosis. Neoadjuvant chemotherapy and early cystectomy did not improve survival outcomes for MPBC patients in this population-level study.

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Area of Science:

  • Oncology
  • Urology
  • Cancer Research

Background:

  • Micropapillary bladder cancer (MPBC) is a rare urothelial carcinoma (UC) variant associated with poor outcomes.
  • Limited data exists on MPBC treatment efficacy outside of single-institution studies.

Purpose of the Study:

  • To assess survival outcomes in MPBC patients treated with surgery, radiation, and/or chemotherapy using a population-level database.
  • To compare treatment modalities for MPBC and general UC.

Main Methods:

  • Utilized the National Cancer Database (NCDB) from 2004-2014.
  • Included cases of MPBC and UC identified by International Classification of Disease-O-3 morphologic codes.
  • Analyzed survival outcomes stratified by radical cystectomy (RC) with or without neoadjuvant (NAC) or adjuvant chemotherapy (AC).

Main Results:

  • 869 MPBC patients and 389,603 UC patients were analyzed.
  • MPBC patients often presented with high-grade, muscle-invasive or locally advanced disease.
  • Neoadjuvant chemotherapy (NAC) did not improve survival for MPBC patients with ≥cT2 disease, unlike in general UC.
  • MPBC histology independently predicted a worse risk of death.

Conclusions:

  • Neoadjuvant chemotherapy and early cystectomy did not demonstrate a survival benefit for MPBC.
  • MPBC histology is an independent predictor of decreased survival.
  • The prognosis for MPBC remains poor regardless of current treatment modalities, necessitating research into novel therapies.