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

Claps F, van de Kamp MW, Mayr R, Bostrom PJ, Shariat SF, Hippe K, Bertz S, Neuzillet Y, Sanders J, Otto W, van der Heijden MS, Jewett MA, Stöhr R, Zlotta AR, Trombetta C, Eckstein M, Mertens LS, Burger M, Soorojebally Y, Wullich B, Bartoletti R, Radvanyi F, Pavan N, Sirab N, Mir MC, Pouessel D, van der Kwast TH, Hartmann A, Lotan Y, Bussani R, Allory Y, van Rhijn BW (2023)

Publication Type: Journal article

Publication year: 2023

Journal

DOI: 10.1111/bju.15984

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.

Authors with CRIS profile

Involved external institutions

Universitätsklinikum Regensburg Germany (DE) Antoni van Leeuwenhoek Netherlands (NL) University of Pisa / Università di Pisa (UniPi) Italy (IT) Institut Curie France (FR) Università degli Studi di Trieste Italy (IT) University of Toronto Canada (CA) Universität Regensburg Germany (DE) University of Texas Southwestern Medical Center (UT Southwestern) United States (USA) (US) Valencia Oncology Institute Foundation / Fundación Instituto Valenciano de Oncología / Fundació Institut Valencià d’Oncologia (IVO) Spain (ES)

How to cite

APA:

Claps, F., van de Kamp, M.W., Mayr, R., Bostrom, P.J., Shariat, S.F., Hippe, K.,... van Rhijn, B.W. (2023). Prognostic impact of variant histologies in urothelial bladder cancer treated with radical cystectomy. Bju International. https://doi.org/10.1111/bju.15984

MLA:

Claps, Francesco, et al. "Prognostic impact of variant histologies in urothelial bladder cancer treated with radical cystectomy." Bju International (2023).

BibTeX: Download