Efficacy of chemotherapy on overall survival in metastatic sarcomatoid bladder cancer patients

INTRODUCTION: The role of chemotherapy in metastatic sarcomatoid bladder cancer (mSBC) is unknown. The current work aimed to test the effect of chemotherapy on overall survival (OS) in mSBC patients. MATERIAL AND METHODS: Using the Surveillance, Epidemiology and End Results database (2001–2018), we identified 110 mSBC patients of all T and N stages (T(any)N(any)M(1)). Kaplan-Meier plots and Cox regression models were used. Covariates consisted of type of surgical treatment (no treatment vs radical cystectomy vs other), and patient age. The endpoint of interest was OS. RESULTS: In 110 mSBC patients, 46 (41.8%) were exposed to chemotherapy vs 64 (58.2%) who were chemotherapy naive. Chemotherapy exposed patients were younger (median age 66 vs 70, p = 0.005). Median OS was 8 months in chemotherapy exposed vs 2 months in chemotherapy naive patients. In univariable Cox regression models, chemotherapy exposure was associated with a hazard ratio (HR) of 0.58 (p = 0.007). In multivariable Cox regression models adjusted for case mix, chemotherapy exposure was associated with a HR of 0.60 (p = 0.016). CONCLUSIONS: To the best of our knowledge, this is the first report of chemotherapy effect on OS in mSBC patients. OS is extremely poor. Nonetheless, it is improved in a statistically significant and clinically meaningful fashion, when chemotherapy is administered.