Resultados perioperatorios y oncológicos a largo plazo de los pacientes con variantes histológicas de cáncer vesical sometidos a cistectomía radical: un análisis de emparejamiento por índices de propensión con carcinoma urotelial puro / The perioperative and long-term outcomes of patients with variant histology bladder cancer undergoing radical cystectomy: A propensity score-matched analysis with pure urothelial carcinoma

Objetivos Evaluar los resultados perioperatorios y a largo plazo de la cistectomía radical en los pacientes con variantes histológicas frente a los pacientes con patrón histológico de carcinoma urotelial puro. Métodos Los pacientes diagnosticados de carcinoma vesical con variantes histológicas fueron emparejados con aquellos diagnosticados de carcinoma urotelial puro en una proporción de 1:3 mediante un análisis de puntuación de propensión. Los 2 grupos se compararon en términos de resultados perioperatorios y morbimortalidad a largo plazo. Resultados En el presente estudio retrospectivo se incluyeron 148 individuos (37 con variantes histológicas de CU y 111 con carcinoma urotelial puro). Un total de 107 (72,3%) individuos presentaron al menos una complicación perioperatoria según la clasificación de Clavien-Dindo. Esta proporción fue similar entre los pacientes con carcinoma urotelial frente a aquellos con variante histológica (p=0,22). En cuanto a las complicaciones a largo plazo, el número de pacientes con hernia incisional clínicamente significativa que requirió cirugía (14 [12,7%] frente a 3 [8,3%]; p=0,68], estenosis uretero-intestinal/uretero-cutánea o cualquier otra complicación relacionada con la derivación urinaria aplicada (15 [13,6%] frente a 7 [19,4%]; p=0,56], o el número de pacientes que presentaron septicemia (17 [15,5%] frente a 10 [27,8%]; p=0,16] u obstrucción del tracto urinario (12 [10,9%] frente a 4 [11,1%]; p>0,99] durante el seguimiento fue similar para el grupo carcinoma urotelial y el de variante histológica. Según el análisis de supervivencia con curvas de Kaplan-Meier y el modelo de regresión de Cox univariante, el riesgo de muerte por cualquier causa era mayor en los pacientes con variante histológica que en los de patrón histológico puro (log-rank test=0,045; hazard ratio: 1,7; intervalo de confianza del 95%: 1,01-2,87; p=0,047). Conclusiones La morbimortalidad perioperatorias son comparables . (AU)

Objectives To assess the perioperative and long-term outcomes after open radical cystectomy in patients with histological variants versus pure urothelial carcinoma. Methods Patients with a variant histology carcinoma of the urinary bladder were matched through a propensity score analysis with those with pure urothelial carcinoma on a 1:3 ratio. The two groups were compared in terms of perioperative and long-term morbidity and mortality. Results Overall, 148 individuals were included in the present retrospective study (37 with variant histology and 111 with pure urothelial carcinoma). A total of 107 (72.3%) individuals presented at least one perioperative complication based on the Clavien-Dindo classification. This proportion was similar between patients with urothelial versus variant histology carcinoma (P=.22). In the long term, the number of patients with clinically significant incisional hernia requiring surgery [14 (12.7%) vs 3 (8.3%), P=.68], uretero-intestinal/uretero-cutaneous strictures or any other complication related to the applied urinary diversion [15 (13.6%) vs 7 (19.4%), P=.56], as well as the number of patients presenting with septicemia [17 (15.5%) vs 10 (27.8%), P=.16] or with urinary tract obstruction [12 (10.9%) vs 4 (11.1%), P>.99] at follow-up did not differ between urothelial versus variant histology carcinoma. The survival analysis with Kaplan-Meier curves and the univariate Cox regression model suggested that the risk of death from any cause was increased in patients with variant compared to pure urothelial histology (log-rank test=.045, hazard ratio: 1.7, 95% confidence interval: 1.01-2.87, P=.047). Conclusions Perioperative morbidity and mortality are comparable in patients with variant histology versus pure urothelial carcinoma. (AU)

The perioperative and long-term outcomes of patients with variant histology bladder cancer undergoing radical cystectomy: A propensity score-matched analysis with pure urothelial carcinoma.

OBJECTIVES: To assess the perioperative and long-term outcomes after open radical cystectomy in patients with histological variants versus pure urothelial carcinoma. METHODS: Patients with a variant histology carcinoma of the urinary bladder were matched through a propensity score analysis with those with pure urothelial carcinoma on a 1:3 ratio. The two groups were compared in terms of perioperative and long-term morbidity and mortality. RESULTS: Overall, 148 individuals were included in the present retrospective study (37 with variant histology and 111 with pure urothelial carcinoma). A total of 107 (72.3%) individuals presented at least one perioperative complication based on the Clavien-Dindo classification. This proportion was similar between patients with urothelial versus variant histology carcinoma (P = .22). In the long term, the number of patients with clinically significant incisional hernia requiring surgery [14 (12.7%) vs 3 (8.3%), P = .68], uretero-intestinal/uretero-cutaneous strictures or any other complication related to the applied urinary diversion [15 (13.6%) vs 7 (19.4%), P = .56], as well as the number of patients presenting with septicemia [17 (15.5%) vs 10 (27.8%), P = .16] or with urinary tract obstruction [12 (10.9%) vs 4 (11.1%), P > .99] at follow-up did not differ between urothelial versus variant histology carcinoma. The survival analysis with Kaplan-Meier curves and the univariate Cox regression model suggested that the risk of death from any cause was increased in patients with variant compared to pure urothelial histology (log-rank test = 0.045, hazard ratio: 1.7, 95% confidence interval: 1.01-2.87, P = .047). CONCLUSIONS: Perioperative morbidity and mortality are comparable in patients with variant histology versus pure urothelial carcinoma.