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. 2023 Aug;132(2):170-180.
doi: 10.1111/bju.15984. Epub 2023 Feb 20.

Prognostic impact of variant histologies in urothelial bladder cancer treated with radical cystectomy

Francesco Claps  1   2 , Maaike W van de Kamp  1 , Roman Mayr  3 , Peter J Bostrom  4   5 , Shahrokh F Shariat  6   7   8   9 , Katrin Hippe  10 , Simone Bertz  11 , Yann Neuzillet  1   12   13 , Joyce Sanders  12 , Wolfgang Otto  3 , Michiel S van der Heijden  14 , Michael A S Jewett  4 , Robert Stöhr  11 , Alexandre R Zlotta  4 , Carlo Trombetta  2 , Markus Eckstein  11 , Laura S Mertens  1 , Maximilian Burger  3 , Yanish Soorojebally  13 , Bernd Wullich  15 , Riccardo Bartoletti  16 , François Radvanyi  13 , Nicola Pavan  2 , Nanour Sirab  13 , M Carmen Mir  17 , Damien Pouessel  13   18 , Theo H van der Kwast  19 , Arndt Hartmann  11 , Yair Lotan  6 , Rossana Bussani  20 , Yves Allory  13   21 , Bas W G van Rhijn  1   3   4
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Free article

Prognostic impact of variant histologies in urothelial bladder cancer treated with radical cystectomy

Francesco Claps et al. BJU Int. 2023 Aug.
Free article

Abstract

Objectives: To evaluate variant histologies (VHs) for disease-specific survival (DSS) in patients with invasive urothelial bladder cancer (BCa) undergoing radical cystectomy (RC).

Materials and methods: We analysed a multi-institutional cohort of 1082 patients treated with upfront RC for cT1-4aN0M0 urothelial BCa at eight centres. Univariable and multivariable Cox' regression analyses were used to assess the effect of different VHs on DSS in overall cohort and three stage-based analyses. The stages were defined as 'organ-confined' (≤pT2N0), 'locally advanced' (pT3-4N0) and 'node-positive' (pTanyN1-3).

Results: Overall, 784 patients (72.5%) had pure urothelial carcinoma (UC), while the remaining 298 (27.5%) harboured a VH. Squamous differentiation was the most common VH, observed in 166 patients (15.3%), followed by micropapillary (40 patients [3.7%]), sarcomatoid (29 patients [2.7%]), glandular (18 patients [1.7%]), lymphoepithelioma-like (14 patients [1.3%]), small-cell (13 patients [1.2%]), clear-cell (eight patients [0.7%]), nested (seven patients [0.6%]) and plasmacytoid VH (three patients [0.3%]). The median follow-up was 2.3 years. Overall, 534 (49.4%) disease-related deaths occurred. In uni- and multivariable analyses, plasmacytoid and small-cell VHs were associated with worse DSS in the overall cohort (both P = 0.04). In univariable analyses, sarcomatoid VH was significantly associated with worse DSS, while lymphoepithelioma-like VH had favourable DSS compared to pure UC. Clear-cell (P = 0.015) and small-cell (P = 0.011) VH were associated with worse DSS in the organ-confined and node-positive cohorts, respectively.

Conclusions: More than 25% of patients harboured a VH at time of RC. Compared to pure UC, clear-cell, plasmacytoid, small-cell and sarcomatoid VHs were associated with worse DSS, while lymphoepithelioma-like VH was characterized by a DSS benefit. Accurate pathological diagnosis of VHs may ensure tailored counselling to identify patients who require more intensive management.

Keywords: #BladderCancer; #blcsm; #uroonc; #utuc; bladder urothelial carcinoma; prognosis; radical cystectomy; survival; variant histology.

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