The role of squamous differentiation in patients with transitional cell carcinoma of the bladder treated with radical cystectomy

Abstract

Objective: We aim at determining the prognostic value of squamous differentiation in patients with transitional cell carcinoma (TCC) of the bladder that were treated with radical cystectomy. Materials and Methods: From January 1993 to January 2005, we retrospectively selected 113 patients. Correlations among squamous differentiation with other clinical and pathological features were assessed by both chi-square and Fisher tests. The Kaplan-Meier method was used to evaluate survival curves and statistical significance was determined by the log-rank test. Multivariate analysis was performed through a Cox proportional hazards regression model. Results: Squamous differentiation was observed in 25 (22.1%) of the 113 patients. This finding was significantly related only to the pathological stage. Mean follow-up after cystectomy was 31.7 ± 28.5 months. Disease recurrence occurred in 16 (64%) and 30 (34%) patients with and without squamous differentiation (log-rank test, p = 0.001), and mortality occurred in 10 (40%) and 14 (16%) of the patients with and without squamous differentiation respectively. Univariate analysis revealed that pathological stage, squamous differentiation, tumor size and lymph node involvement were significant predictors of cancer-specific survival. However, only squamous differentiation and tumor size were independent prognostic variables on multivariate analysis. Conclusions: Squamous differentiation was an independent prognostic factor for cancer specific survival in patients with bladder cancer treated with radical cystectomy. Further studies with a larger number of patients are necessary to confirm these results.

Does Squamous Differentiation Portend Worse Outcomes in Urothelial Bladder Cancer?

“…Consistent with the TURBT findings, SQD have historically been known to have more advanced pathologic disease 7,8,23 . Kim et al found that variant tumors had almost double the incidence of non-organ confined disease as well as increased LN involvement 7 .…”

“…As one of the first classified variants, squamous differentiation (SQD) has consistently been described as the most common variant subtype, comprising anywhere between 30-80% of variant bladder cancers 2,3,[6][7][8][9][10] . Although SQD was previously shown to be associated with higher pathologic staging and increased risk of local recurrence, when accounting for stage, SQD does not alter overall survival (OS) or disease-specific survival (DSS) 7,8,[11][12][13] .…”

“…Although SQD was previously shown to be associated with higher pathologic staging and increased risk of local recurrence, when accounting for stage, SQD does not alter overall survival (OS) or disease-specific survival (DSS) 7,8,[11][12][13] . Furthermore, there is evidence suggesting that SQD may be equally sensitive to chemotherapy as non-variant (NV) urothelial bladder cancer 10,12,[14][15][16][17] .…”

1593 Comparative Outcomes of Pure Squamous Cell Carcinoma and Urothelial Carcinoma With Squamous Differentiation in Patients Treated With Radical Cystectomy

“…13 Our results validate previous studies that suggest SqD, compared to conventional urothelial carcinoma, is an adverse pathological feature associated with worse CSS and OS. 6,7 The incidence of SqD varies considerably among published series because no strict pathological criteria have been defined. 7,14,15 Histologically SqD is characterized by the presence of intercellular bridges or keratinization.…”

“…[3][4][5] Compared to conventional urothelial carcinoma, SqD is an adverse pathological feature associated with worse recurrence-free and cancer specific survival. 6,7 Similarly, compared to conventional urothelial carcinoma, SCC has been associated with adverse oncologic outcomes after adjusting for the effects of stage and common prognostic factors. 8 To our knowledge no study has compared the clinical outcomes of patients with SCC to the outcomes of those with SqD.…”