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Randomized Controlled Trial
. 2013 Feb 8:13:71.
doi: 10.1186/1471-2407-13-71.

Plasmacytoid variant of bladder cancer defines patients with poor prognosis if treated with cystectomy and adjuvant cisplatin-based chemotherapy

Bastian Keck  1 , Sven Wach, Robert Stoehr, Frank Kunath, Simone Bertz, Jan Lehmann, Michael Stöckle, Helge Taubert, Bernd Wullich, Arndt Hartmann
Affiliations
Randomized Controlled Trial

Plasmacytoid variant of bladder cancer defines patients with poor prognosis if treated with cystectomy and adjuvant cisplatin-based chemotherapy

Bastian Keck et al. BMC Cancer. .

Abstract

Background: Since the definition of different histologic subtypes of urothelial carcinomas by the World Health Organization (WHO) 2004 classification, description of molecular features and clinical behavior of these variants has gained more attention.

Methods: We reviewed 205 tumor samples of patients with locally advanced bladder cancer mainly treated within the randomized AUO-AB05/95 trial with radical cystectomy and adjuvant cisplatin-based chemotherapy for histologic subtypes. 178 UC, 18 plasmacytoid (PUC) and 9 micropapillary (MPC) carcinomas of the bladder were identified. Kaplan Meier analysis and backward multivariate Cox's proportional hazards regression analysis were performed to compare overall survival between the three histologic subtypes.

Results: Patients suffering from PUC have the worst clinical outcome regarding overall survival compared to conventional UC and MPC of the bladder that in turn seem have to best clinical outcome (27.4 months, 62.6 months, and 64.2 months, respectively; p=0.013 by Kaplan Meier analysis). Backward multivariate Cox´s proportional hazards regression analysis (adjusted to relevant clinicopathological parameters) showed a hazard ratio of 3.2 (p=0.045) for PUC in contrast to patients suffering from MPC.

Conclusions: Histopathological diagnosis of rare variants of urothelial carcinoma can identify patients with poor prognosis.

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Figures

Figure 1
Figure 1
Hematoxylin and eosin staining (200x): Plasmacytoid urothelial carcinoma showing a characteristic single cell growth pattern with eccentrically located nuclei and abundant eosinophilic cytoplasm.
Figure 2
Figure 2
Hematoxylin and eosin staining (200x): Micropapillary carcinoma with medium sized tumor cells and eosinophilic cytoplasm that typically arrange in small nests and show slender, delicate processes, often with a central fibrovascular core.
Figure 3
Figure 3
Kaplan-Meier analysis: Correlation of histology subtype with overall survival. Patients with a plasmacytoid urothelial cancer (lower curve, N=18) showed with 27.4 months (range: 16.8-37.9) the shortest overall survival, patients with a conventional UC (middle curve, N=178) survived in average 62.6 months (range: 54.8-70.4) whereas patients with a micropapillary urothelial cancer possessed the longest average survival with 64.2 months (range: 41.9-86.4; upper curve N=9). The mean survival was significantly different between patients with plasmacytoid urothelial cancer and those with micropapillary urothelial cancer (P=0.013; log rank test). Censoring of patients (marked with a cross) means mathematically removing a patient from the survival curve at the end of his/her follow-up time.
Figure 4
Figure 4
Multivariate Cox’s regression hazard analysis (adjusted to age, sex, tumor grade, tumor stage, lymph node and metastases status, type of chemotherapy): Correlation of histology subtype with overall survival. Patients with a plasmacytoid urothelial cancer (lower curve; N=18) have a 3.2-fold (95% CI: 1.0-9.9; P=0.045) increased risk of death while patients with conventional UC (middle curve; N=178) have a 1.3-fold (95% CI: 0.5-3.7; P=0.558) but not significant increased risk of death compared with patients with a micropapillary urothelial cancer (upper curve, N=9).
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