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Título

PREDICTING INDIVIDUAL OUTCOMES AFTER RADICAL CYSTECTOMY IN UROTHELIAL VARIANTS WITH CANCER OF THE BLADDER RISK ASSESSMENT (COBRA) SCORE.

Resumo

ABSTRACT

INTRODUCTION AND OBJECTIVE:
Urothelial carcinoma (UC), which accounts for approximately 90% of all bladder cancer (BCa), is a heterogeneous disease with several histological subtypes. Urothelial variants (UV) are a diverse group of BCa subtypes, each with distinct biological and clinical features. The Cancer of the Bladder Risk Assessment (COBRA) score incorporates the age of the patient, lymph node density (LND), and clinical tumor staging.
The objective of this study is to examine the impact of UV on the outcomes of patients undergoing radical cystectomy for BCa. We aim to identify any differences in clinical and pathological characteristics, treatment outcomes, and survival rates among patients with different UV.
METHODS:
The institutional review boards of Cancer Institute of the State of São Paulo (ICESP) at the University of São Paulo approved this study. The data were extracted of all patients with BCa already undergoing to radical cystectomy in the institution utilizing Electronic medical records and surgery notes were reviewed. In total, 667 patients with urothelial BCa received surgical treatment with open radical cystectomy (RC) at the ICESP between May 2008 and January 2022, and 167 with UV were analyzed, and the COBRA score was applied. Patients who had extra-nodal metastases at diagnosis and those who were missing lymph node (ND) counts were excluded.
RESULTS:
A total of 167 patients who had UV and all nomogram variables documented were selected for validation analysis. The mean age of the patients was 66.98 (9.46), a majority of male patients (64.7%). Thirteen distinct types of histological variants were documented, the four most frequent being Squamous (50.89%), Glandular (31.34%), Micropapillary (11.37%) and Sarcomatoid (7.91%).The Kaplan Meier curve stratified by variants and the log rank test (p<0.05) indicated the sarcomatoid variant as the one that presented the worst oncological prognosis in 2 and 5 years, presenting higher specific cancer mortality and recurrence. The COBRA score correlated with cancer prognosis in each histological variant when survival analysis was performed with the Kaplan Meier test and log rank (p<0.05).
CONCLUSION:
The sarcomatoid variant presented worse oncological outcomes and COBRA score is a significant predictor of overall and cancer-specific survival in UV.