The impact of non‐urothelial variant histology on oncological outcomes following radical cystectomy

Stroman, Luke; Nair, Rajesh; Russell, Beth; Malik, Nabiah; Desai, Arjun; Chandra, Ashish; Thurairaja, Ramesh; Khan, Muhammad Shamim; Malde, Sachin

doi:10.1111/bju.14704

Cited by 23 publications

(12 citation statements)

References 14 publications

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“…We report that 43% of patients had VH, with SQD (16%), mixed VH (9.9%) and MPV (5.5%) being the most common variants. Although the frequency of VH reported in our cohort is superior of those reported in largest series published in the past few years, which have found prevalences of VH between 17-32%, VH subtypes proportions is in concordance, being SQD and MPV between the most common variants reported (8)(9)(10)(11).…”

Section: Resultscontrasting

confidence: 83%

Variant histologies of urothelial carcinoma: Does it change the survival outcomes in patients managed with radical cystectomy?

Pereira

Reis

Braga

et al. 2022

Arch Ital Urol Androl

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Objective: To investigate the impact of variant histologies (VH) of urothelial carcinoma (UC) on survival outcomes after radical cystectomy (RC). Materials and methods: Data from 181 patients with UC treated with RC between January 2013 and December 2019 at a single tertiary care referral center were retrospectively accessed. All RC specimens were assigned by genitourinary dedicated pathologists. Overall survival (OS), disease-specific survival (DSS) and recurrence-free survival (RFS) were evaluated using the Kaplan-Meier methodology and the Cox proportional hazards regression. Results: Of 181 patients, 43.1% (n = 78) had VH, with the most common being squamous differentiation (n = 29), followed by mixed variants (n = 18), micropapillary variant (n = 10) and other subtypes (n = 21). The median (range) follow-up was 35 (18-59) months. Kaplan-Meier survival analysis shows that median OS and DS were significantly worse for VH patients (78 vs 31 months, p = 0.038; not reached vs 42 months; p = 0.016). At 5 years, VH was associated with a 12% and 14% decrease in OS and DSS, respectively. No significant statistical difference between the two groups was reached regarding RFS. However, after adjusting for confounders, such as, demographics characteristics, comorbidities and pathological features, VH were not associated with any survival outcomes. Conclusions: Our study evidenced the high incidence of bladder cancers with VH. Although clearly associated with features of more aggressive behavior, VH had not any significant impact in survival expectancies when all confounders are adjusted in multivariate analyses.

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Section: Resultscontrasting

confidence: 83%

Variant histologies of urothelial carcinoma: Does it change the survival outcomes in patients managed with radical cystectomy?

Pereira

Reis

Braga

et al. 2022

Arch Ital Urol Androl

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“…These different histologic subtypes have been suggested to differ in terms of risk factors, prognostic indicators, clinical outcomes, response to treatment modalities, and even incidence. [5][6][7][8][9][10][11][12][13][14] One study, using the SEER United States population dataset, showed a decreased incidence of SCC of the bladder from 1973 to 2013. 5 However, the clinical significance of squamous differentiation and pure SCC of the bladder continues to be debated.…”

Section: Introductionmentioning

confidence: 99%

The Significance of Squamous Histology on Clinical Outcomes and PD-L1 Expression in Bladder Cancer

et al. 2021

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Objectives. To compare the clinicopathologic characteristics of urothelial carcinoma (UC), urothelial carcinoma with squamous differentiation (UCSD), and squamous cell carcinoma (SCC) of the bladder, which have been suggested to differ in terms of risk factors, immunophenotype, and prognosis. Methods. We evaluated the clinicopathologic features of radical cystectomy specimens between 1980 and 2015 with a diagnosis of SCC, UCSD, and UC. PD-L1 immunohistochemistry (clinically available clones 22C3, SP142, and SP263) was performed on SCC and UCSD. Multivariate Cox regression was used to identify prognostic factors. Kaplan–Meier curves were plotted to assess cancer-specific survival (CSS). Results. Of the 1478 cases, there were 1126 UC (76%), 217 UCSD (15%), and 135 SCC (9%). Bladder cancer was more common in men than women (80% vs 20%, P < .0001). However, a higher proportion of SCC and UCSD occurred in women (SCC-36%, UCSD-22%, UC-18%). Women were significantly more likely to be never smokers in all 3 cohorts (UC: 45% vs 16%, UCSD: 44% vs 12%, SCC: 40% vs 18%, P < .0001). Patients with SCC and UCSD were at a higher pathologic stage (>pT2) at the time of cystectomy (UCSD-74%, SCC 71%, UC-44%, P < .0001) and had worse CSS compared to patients with UC ( P = 0.006). SCC had higher PD-L1 scores (all clones) than UCSD ( P < .0001). PD-L1 22C3 ( P = .02, HR: 0.36) and SP142 scores ( P = .046, HR: 0.27) predicted CSS on Kaplan–Meier analysis for SCC cases. Conclusions. UC, UCSD, and SCC are associated with different risk factors, gender distributions, and clinical outcomes. PD-L1 is expressed in SCC and UCSD, suggesting some patients may benefit from targeted therapy.

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“…Stroman et al reported a decrease in overall survival in patients with histological variants at 14% at 2 years and 23% at 5 years after RC compared to pure UC. Patients should be informed about the high risk and unpredictable nature of these entities and the recommendation for the first RC performed for this indication [17].…”

Section: Discussionmentioning

confidence: 99%

Histology of variants of urothelial carcinoma of the bladder: a Moroccan series of 39 cases

Saouli¹,

Karmouni²,

Khader³

et al. 2021

Afr J Urol

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Background The variant of urothelial carcinoma (UCV) is a rare and aggressive histological entity; its therapeutic management remains debated. Methods Between January 2017 and October 2019, 39 patients were diagnosed retrospectively with urothelial carcinoma with a histological variant. The aim of this study was to analyze the clinico-pathological and therapeutic aspects of these variants to better understand this invasive disease. Results In 39 cases, 36 (92%) were men and 3 (8%) were women; the average age was 62 years; 54% of patients had a ≥ cT3 stage with clinical lymph node involvement in 28% and 23% had distant metastases, 36% of patients were treated with RC and 54% by other therapeutic and 10% refused RC. No patient received neoadjuvant chemotherapy. Lymph node involvement was 28.5%. The two predominant histological types were squamous and micropapillary differentiation between the operating piece and bladder biopsy 28.5%, 30% and 21.5% and 13%, respectively. The overall survival at 20 months was 70 and 40% for RC and the other therapeutic (TURB alone or a TURB with an adjuvant), respectively. There was no significant difference in survival between the two groups (p = 0.27). Conclusion UCVs are heterogeneous groups of tumors which are increasingly identified due to their distinct morphological characteristics with variable clinical prognosis. Therapeutic management is not in favor of cystectomy in our study. However, a prospective study using a larger cohort is still necessary to validate our results.

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The impact of non‐urothelial variant histology on oncological outcomes following radical cystectomy

Cited by 23 publications

References 14 publications

Variant histologies of urothelial carcinoma: Does it change the survival outcomes in patients managed with radical cystectomy?

Variant histologies of urothelial carcinoma: Does it change the survival outcomes in patients managed with radical cystectomy?

The Significance of Squamous Histology on Clinical Outcomes and PD-L1 Expression in Bladder Cancer

Histology of variants of urothelial carcinoma of the bladder: a Moroccan series of 39 cases

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