Clinicopathological analysis and outcomes of inflammatory myofibroblastic tumours of the urinary bladder

Patrick J. Hensley, Kelly K. Bree, Charles C. Guo, Niyati Lobo, Matthew T. Campbell, Curtis A. Pettaway, Ashish M. Kamat

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: To describe clinical, imaging, and histopathological characteristics of inflammatory myofibroblastic tumour (IMT) of the urinary bladder and provide initial management and surveillance recommendations. Patients and Methods: We identified patients with IMT of the bladder treated at our facility from 1998 to 2020. Categorical variables were analysed with chi-square and Fisher’s exact tests and continuous variables with the Mann–Whitney U-test. Kaplan–Meier analysis was performed for recurrence-free survival. Results: IMT was diagnosed in 35 patients with median (interquartile range [IQR]) follow-up of 20 (11.5–68.5) months. At initial diagnosis 86% were clinically organ-confined, 9% locally advanced, and 5% metastatic. Majority of patients (92%) had residual disease on re-staging transurethral resection (TUR). Of the 15 patients with organ-confined disease managed initially with TUR alone, five (33%) recurred at a median (IQR) of 5 (3.0–5.5) months from initial diagnosis. Presentation with visible haematuria was associated with recurrence (100% in recurrence vs 40% in non-recurrence groups, P = 0.044). There were no patients who developed a recurrence beyond 6 months after diagnosis. Partial or radical cystectomy was required in 23% and 9% of patients, respectively. One patient presented with metastatic disease associated with anaplastic lymphoma kinase (ALK) translocation and achieved a durable complete remission with 7 months of crizotinib therapy. Conclusions: No patient with IMT treated with aggressive endoscopic management developed recurrences beyond 6 months. There were additionally no recurrences noted after definitive radical or partial cystectomy. These data support organ sparing therapy with aggressive endoscopic management and short-term surveillance in patients with localised IMT, with extirpative surgery reserved for refractory cases.

Original languageEnglish
JournalBJU International
DOIs
StateAccepted/In press - 2021

Bibliographical note

Funding Information:
Kelly K. Bree, stock options from Stratify Genomis. Ashish M. Kamat, personal fees and other from BMS, FKD Industries, Merck, Photocure; personal fees from: Abbott Molecular, Arquer, ArTara, Asieris, Astra Zeneca, BioClin Therapeutics, Cepheid, Cold Genesys, Eisai, Engene, Inc., Ferring, FerGene, Imagin, Janssen, MDxHealth, Medac, Pfizer, Roviant, Sessen Bio, ProTara, Nucleix, Seattle Genetics, Theralase, TMC Innovation, US Biotest; grants from CEC Oncology; other from: Adolor, Heat Biologics; patent for CyPRIT‐Cytokine Panel for Response to Intravesical Immunotherapy pending. Matthew T. Campbell, advisory board/honorarium: Eisai, Exelixis, SeaGen, Astellas, Pfizer, EMD Serono; consulting: Exelixis, AXDEV; research funding: Janssen, Exelixis, EMD Serono, Pfizer, ApricityHealth, AstraZeneca; non‐branded education: Medscape, Astellas. in situ

Funding Information:
This research was supported by the Wayne B. Duddlesten Professorship in Cancer Research, the Raymond, and Maria Floyd Bladder Cancer Research Foundation Grant to Ashish M. Kamat, and a Urology Care Foundation Research Scholars Award to Patrick J. Hensley (IRG 85‐001‐25).

Publisher Copyright:
© 2021 The Authors BJU International © 2021 BJU International

Keywords

  • anaplastic lymphoma kinase
  • crizotinib
  • inflammatory myofibroblastic tumour
  • radical cystectomy
  • transurethral resection

ASJC Scopus subject areas

  • Urology

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