Abstract
681
Background: Squamous Cell Carcinoma (SCC) is a rare subtype of bladder cancers, consisting of 2-5% of all bladder cancers. SCC is associated with chronic bladder inflammation often due to catheters, kidney stones, and bladder outlet obstruction. While gold standard treatment for SCC is radical cystectomy (RC), many patients receive more extensive surgery such as pelvic exenteration (PE). PE involves removing all organs from a person’s pelvic cavity whereas RC involves removing the bladder and nearby tissue. This study will examine the characteristics of metastatic SCC patients receiving PE vs RC to better understand why some patients may not receive RC. Methods: The National Cancer Database (NCDB) was used to identify patients diagnosed with bladder squamous cell carcinoma from 2004 to 2020 using the histology codes 8050, 8070-8076, 8084 and NCDB analytic stage code IV as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA Chi-Square, and Cox Proportional Hazards tests were performed. Data was analyzed using SPSS version 27 and statistical significance was set at α = 0.05. Results: Of the 561 patients in the sample, 211 (37.6%) received PE and 350 (62.4%) received RC. Patients receiving PE survived 32.8 months and patients receiving RC survived 35.8 months (p>0.05). Patients receiving PE were more likely to receive adjuvant radiation or chemoradiation, have no residual tumor or microscopic residual tumor after surgery, receive care from an academic facility, and to have lymph vascular invasion (p<0.05). These patients were also more likely to present at a younger age (62.86 vs 65.37 years) yet interestingly were more likely to have fewer regional lymph nodes positive (9.27 vs 14.90) (p<0.05). There were no significant differences between income level, race, the number of comorbid conditions (Charlson-Deyo Score), insurance status, tumor size, or time to surgery (p>0.05) between the two groups. Conclusions: 37.6% of patients in this sample received PE over RC, the gold standard. PE patients had disease that more greatly invaded the lymphatics and had better surgical margins, yet PE offered no significant survival benefit. More research is needed to better understand why some patients receive more extensive surgical intervention.