Editorial Comment

Abstract

Upper tract urothelial carcinoma (UTUC) with variant histology (VH) is an aggressive disease with poor outcomes. 1 Whether this is due to higher stage at presentation, differences in underlying biologydor bothdremains unclear. This study seeks to better delineate the clinical significance of UTUC with VH, and the authors show VH is associated with higher pathological stage and poorer survival compared to pure urothelial carcinoma (UC). Critically, though, there were no differences in oncologic outcomes after accounting for tumor stage.At first glance, this important finding might suggest that VH on surgical pathology should not factor into decision making regarding the need for adjuvant chemotherapy. However, increasing evidence suggests chemotherapy is especially important in patients with VH. Adjuvant chemotherapy was associated with a survival improvement in 1 study of patients with VH. 2 In another study, VH was associated with worse survival compared to UC except in the subset of patients receiving adjuvant chemotherapy, where outcomes were similar. 3