Upstaging of nonurothelial histology in bladder cancer at the time of surgical treatment in the National Cancer Data Base

Purpose To determine patient and pathologic characteristics as well as outcomes for patients with clinically localized, nonurothelial histology bladder cancer. Materials and methods Using the National Cancer Data Base, we identified patients between 2000 and 2010 diagnosed with bladder cancer as their only malignancy undergoing definitive surgical management. Patients were characterized as urothelial (n = 13,442), squamous (n = 789), small cell (n = 124), adenocarcinoma (n = 789), or other histology (n = 499). Patient and pathologic characteristics were compared across histologic subtypes. We also evaluated for incidence of T and N upstaging. Survival analysis was performed using the Kaplan-Meier method. Multivariate survival analysis was performed to identify predictors of adverse overall survival. Results Patients with nonurothelial histology were more likely to be African-American, treated at academic medical centers, and of younger age (all P<0.05). Among those with nonurothelial histology, 55.4% of patients presenting with clinical stage T1 or less had their tumor upstaged during definitive surgical treatment compared to 42.7% of those with urothelial carcinoma. Squamous histology incurred the highest upgrading rate of 61.8%. Five-year survival varied by subtype, with universally decreased survival for those upstaged. Among nonurothelial histology, overall 5-year survival was 32.4% (95% CI: 28.8%–36.2%) vs. 46.0% (95% CI: 42.3%–49.6%) for those upstaged and not upstaged, respectively. Neoadjuvant therapy is used infrequently in this population. Conclusion We present the largest survival analysis of various rare subtypes of bladder cancer to date. Patients with nonurothelial bladder cancer have significantly higher rate of upstaging at cystectomy and with this a worsened overall survival. Aggressive treatment should be strongly considered for nonurothelial cancers when identified.