This Month in Adult Urology

Abstract

Variant histology (VH) is recognized as a poor prognostic parameter in patients with bladder cancer. Although its aggressive nature is known, details about what differences should occur in management strategy are uncertain. Two papers in this issue of The Journal investigate aspects of VH. Martini et al (page 885) showed in a multi-institutional comparative study that patients with VH had a lower recurrence risk survival 10 years after cystectomy than those with pure urothelial carcinoma (UC), at 30% vs 51%, respectively. 1 Micropapillary variant had a higher risk of abdominal or lung metastasis compared to UC while mixed variants were more likely to have bone metastasis. The authors recommended followup for tumor recurrence for 10 years in those with VH.The impact of neoadjuvant chemotherapy (NAC) in patients with VH was studied by Chakiryan et al (page 924) from Tampa, Florida. 2 Using the National Cancer Database, 31,218 patients who had radical cystectomy were analyzed. NAC was associated with pathological downstaging to P0 in all histological groups. Also, NAC was associated with improved overall survival for UC, sarcomatoid UC, and neuroendocrine carcinoma. Taken together, these manuscripts advance understanding of VH and permit a more personalized management approach.