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Introduction: To examine oncologic outcomes and response to neoadjuvant chemotherapy (NAC) in patients with sarcomatoid urothelial carcinoma (SUC) treated with radical cystectomy (RC)., Materials and Methods: We retrospectively queried our institutional database (2003-18) and Surveillance, Epidemiology, and End Results (SEER)-Medicare (2004-2015) for patients with cT2-4, N0-2, M0 SUC and conventional UC (CUC) treated with RC. Clinicopathologic characteristics were described using descriptive statistics (t test, χ2-test and log-rank-test for group comparison). Overall (OS) and recurrence-free-survival (RFS) after RC were estimated with the Kaplan Meier method and associations with OS were evaluated with Cox proportional hazards models., Results: We identified 38 patients with SUC and 287 patients with CUC in our database, and 190 patients with SUC in SEER-Medicare. In the institutional cohort, patients with SUC versus CUC had higher rates of pT3/4 stage (66% vs. 35%, P < 0.001), lower rates of ypT0N0 (6% vs. 35%, P = .02), and worse median OS (17.5 vs. 120 months, P < .001). Further, patients with SUC in the institutional versus SEER-Medicare cohort had similar median OS (17.5 vs. 21 months). In both cohorts, OS was comparable between patients with SUC undergoing NAC+RC vs. RC alone (17.5 vs. 18.4 months, P = .98, institutional cohort; 24 vs. 20 months, P = .56, SEER cohort). In Cox proportional hazards models for the institutional RC cohort, SUC was independently associated with worse OS (HR 2.3, CI 1.4-3.8, P = .001)., Conclusion: SUC demonstrates poor pathologic response to NAC and worse OS compared with CUC, with no OS benefit associated with NAC. A unique pattern of rapid abdominopelvic cystic recurrence was identified., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Perioperative blood transfusion (PBT) has been associated with worse outcomes across tumor types, including bladder cancer. We report our institutional experience with PBT utilization in the setting of radical cystectomy (RC) for patients with bladder cancer, exploring whether timing of PBT receipt influences perioperative and oncologic outcomes., Methods: Consecutive patients with bladder cancer treated with RC were identified. PBT was defined as red blood cell transfusion during RC or the postoperative admission. Clinicopathologic and peri and/or postoperative parameters were extracted and compared between patients who did and did not receive PBT using Mann Whitney U Test, chi-square, and log-rank test. Overall (OS) and recurrence-free survival (RFS) were estimated with the Kaplan Meier method. Univariate/multivariate logistic and Cox proportional hazards regression were used to identify variables associated with postoperative and oncologic outcomes, respectively., Results: The cohort consisted of 747 patients (77% men; median age 67 years). Median follow-up was 61.5 months (95% CI 55.8-67.2) At least one postoperative complication (90-day morbidity) occurred in 394 (53%) patients. Median OS and RFS were 91.8 months (95% CI: 76.0-107.6) and 66.0 months (95% CI: 48.3-83.7), respectively. On multivariate analysis, intraoperative, but not postoperative, BT was independently associated with shorter OS (HR: 1.74, 95% CI: 1.32-2.29) and RFS (HR: 1.55, 95%CI: 1.20-2.01), after adjusting for relevant clinicopathologic variables. PBT (intra- or post- operative) was significantly associated with prolonged postoperative hospitalization ≥10 days., Conclusions: Intraoperative BT was associated with inferior OS and RFS, and PBT overall was associated with prolonged hospitalization following RC. Further studies are needed to validate this finding and explore potential causes for this observation., Competing Interests: Conflict of interest Leonidas N. Diamantopoulos: no conflicts to disclose;Rishi R. Sekar: no conflicts to disclose; Sarah K. Holt: no conflicts to disclose; Ali R. Khaki: no conflicts to disclose; Natalie J Miller: no conflicts to disclose; Adam Gadzinski: no conflicts to disclose; Yaw A. Nyame: no conflicts to disclose; Brian R. Winters: no conflicts to disclose; Funda Vakar-Lopez: no conflicts to disclose; Maria S. Tretiakova: no conflicts to disclose; Sarah P. Psutka: Honoraria - Prime; Education; Travel, Accommodations, Expenses - Prime Education. John L. Gore: Research Grant funding from Ferring Pharmaceuticals.Daniel W. Lin: DSMB for the POTOMAC study with AstraZeneca; Consulting or Advisory Role – Astellas Pharma, Clovis Oncology, Dendreon; Research Funding – GenomeDx; Genomic Health; MDxHealth. George R. Schade: Patents, Royalties, Other Intellectual Property - Global Cancer Technology. Andrew C. Hsieh: Honoraria - Hotspot Therapeutics; Research Funding - eFFECTOR Inc; Patents, Royalties, Other Intellectual Property - MTOR modulators and uses thereof Patent number: 9629843; Use Of Translational Profiling To Identify Target Molecules For Therapeutic Treatment, Publication number: 20140288097. John K. Lee: Research Funding - Immunomedics; Todd Yezefski: no conflicts to disclose; Michael T. Schweizer: Paid consultant to  Resverlogix. He has received research funding to his institution from Immunomedics, Janssen, AstraZeneca, Pfizer, Madison Vaccines, Tmunity and Hoffmann-La Roche. Heather H. Cheng: Research Funding - Astellas Medivation, Clovis Oncology, Color Foundation, Janssen, Sanofi. Consulting for AstraZeneca. Royalties – UpToDate. Evan Y. Yu: consulting for Abbvie, Advanced Accelerator Applications, Amgen, AstraZeneca, Bayer, Clovis, Dendreon, Incyte, Janssen, Merck, Pharmacyclics, QED, Sanofi, and Seattle Genetics; institutional research support from Bayer, Blue Earth, Daiichi-Sankyo, Dendreon, Merck, Pharmacyclics, Taiho, and Seattle Genetics (all unrelated in last 3 years).Lawrence D. True: Stock and Other Ownership Interests – Lightspeed Micro Research Funding, Ventana Medical Systems; Patents, Royalties, Other Intellectual Property – Lens on an open-top lightsheet microscope. Robert B. Montgomery: Research Funding – AstraZeneca, ESSA, Ferring, Janssen Oncology. Petros Grivas (all unrelated in the last 3 years): consulting for AstraZeneca, Bayer, Bristol-Myers Squibb, Clovis Oncology, Dyania Health, Driver, EMD Serono, Exelixis, Foundation Medicine, GlaxoSmithKline, Genentech, Genzyme, Heron Therapeutics, Immunomedics, Janssen, Merck, Mirati Therapeutics, Pfizer, Roche, Seattle Genetics, QED Therapeutics; institutional research funding from AstraZeneca, Bavarian Nordic, Bayer, Bristol-Myers Squibb, Clovis Oncology, Debiopharm, Genentech, GlaxoSmithKline, Immunomedics, Kure It Cancer Research, Merck, Mirati Therapeutics, Oncogenex, Pfizer, QED Therapeutics. Jonathan L. Wright: Royalties – UpToDate; Clinical Trials - Movember Foundation, Merck, Nucleix, Altor Biosciences; Consulting – Sanofi Genzyme., (Published by Elsevier Inc.)

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., (Published by Elsevier Inc.)