TY - JOUR
T1 - Prognostic impact of variant histologies in urothelial bladder cancer treated with radical cystectomy
AU - Claps, Francesco
AU - van de Kamp, Maaike W.
AU - Mayr, Roman
AU - Bostrom, Peter J.
AU - Shariat, Shahrokh F.
AU - Hippe, Katrin
AU - Bertz, Simone
AU - Neuzillet, Yann
AU - Sanders, Joyce
AU - Otto, Wolfgang
AU - van der Heijden, Michiel S.
AU - Jewett, Michael A.S.
AU - Stöhr, Robert
AU - Zlotta, Alexandre R.
AU - Trombetta, Carlo
AU - Eckstein, Markus
AU - Mertens, Laura S.
AU - Burger, Maximilian
AU - Soorojebally, Yanish
AU - Wullich, Bernd
AU - Bartoletti, Riccardo
AU - Radvanyi, François
AU - Pavan, Nicola
AU - Sirab, Nanour
AU - Mir, M. Carmen
AU - Pouessel, Damien
AU - van der Kwast, Theo H.
AU - Hartmann, Arndt
AU - Lotan, Yair
AU - Bussani, Rossana
AU - Allory, Yves
AU - van Rhijn, Bas W.G.
N1 - Publisher Copyright:
© 2023 BJU International.
PY - 2023/8
Y1 - 2023/8
N2 - 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.
AB - 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.
KW - #BladderCancer
KW - #blcsm
KW - #uroonc
KW - #utuc
KW - bladder urothelial carcinoma
KW - prognosis
KW - radical cystectomy
KW - survival
KW - variant histology
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U2 - 10.1111/bju.15984
DO - 10.1111/bju.15984
M3 - Article
C2 - 36748180
AN - SCOPUS:85148512735
SN - 1464-4096
VL - 132
SP - 170
EP - 180
JO - BJU international
JF - BJU international
IS - 2
ER -