Prognostic impact of variant histologies in urothelial bladder cancer treated with radical cystectomy
- Authors: Claps, F.; Van De Kamp, M.W.; Mayr, R.; Bostrom, P.J.; Shariat, S.F.; Hippe, K.; Bertz, S.; Neuzillet, Y.; Sanders, J.; Otto, W.; Van Der Heijden, M.S.; Jewett, M.A.S.; Stöhr, R.; Zlotta, A.R.; Trombetta, C.; Eckstein, M.; Mertens, L.S.; Burger, M.; Soorojebally, Y.; Wullich, B.; Bartoletti, R.; Radvanyi, F.; Pavan, N.; Sirab, N.; Mir, M.C.; Pouessel, D.; Van Der Kwast, T.H.; Hartmann, A.; Lotan, Y.; Bussani, R.; Allory, Y.; Van Rhijn, B.W.G.
- Publication year: 2023
- Type: Articolo in rivista
- Key words: #BladderCancer; #blcsm; #uroonc; #utuc; bladder urothelial carcinoma; prognosis; radical cystectomy; survival; variant histology;
- OA Link: http://hdl.handle.net/10447/640248
Abstract
ObjectivesTo evaluate variant histologies (VHs) for disease-specific survival (DSS) in patients with invasive urothelial bladder cancer (BCa) undergoing radical cystectomy (RC). Materials and MethodsWe 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). ResultsOverall, 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. ConclusionsMore 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.