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Thomas Flaig, MD
Thomas Flaig, MD
Posted: Wednesday, September 21, 2022
In a retrospective cohort study published in JCO Precision Oncology, researchers at Memorial Sloan Kettering Cancer Center (MSK) aimed to characterize oncologic outcomes after surgical resection and to define the genomic profile of bladder neoplasms with glandular morphology in patients with bladder and urachal adenocarcinoma, urothelial carcinoma with glandular differentiation, and urothelial carcinoma not otherwise specified. The study authors also highlighted how genomic sequencing may help to identify alterations to guide therapeutic decisions.
Conducted by Gopa Iyer, MD, of the Department of Medicine at MSK, the researchers created surgical and genomic cohorts: bladder adenocarcinoma (n = 37), urachal adenocarcinoma (n = 46), urothelial carcinoma with glandular differentiation (n = 84), and urothelial carcinoma not otherwise specified (n = 1,049). The surgical cohort included all patients with bladder or urachal adenocarcinoma managed with partial or radical cystectomy between 1995 and 2018 at MSK. Patients with urothelial carcinoma not otherwise specified included those treated with radical cystectomy from 2005 to 2015. Patients in the genomic cohort had tumor sequencing using targeted next-generation sequencing, a hybridization capture-based targeted exon-sequencing platform of up to 468 cancer-associated genes (MSK Integrated Mutation Profiling of Actionable Cancer Targets).
No significant differences in recurrence or cancer-specific survival between glandular variants and urothelial carcinoma not otherwise specified were found, despite more advanced disease with bladder and urachal adenocarcinomas. The genomic profiles of bladder and urachal adenocarcinomas resembled colorectal adenocarcinoma with KRAS and other gene alterations. The genomic profile of urothelial carcinoma with glandular differentiation, on the other hand, more closely resembled urothelial carcinoma not otherwise specified, including frequent DNA damage response gene alterations.
“Taken together, these data suggest that neoadjuvant chemotherapy should be further studied in patients with [urothelial carcinoma] with glandular differentiation, and genomic sequencing should be considered in patients with adenocarcinoma to guide treatment selection,” stated Dr. Iyer and colleagues.
Disclosure: Full authors’ disclosures are available at www.ascopubs.org.
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