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Alqahtani MA, Alghafees MA, Musalli ZF, Alwatban SM, Alasker A. Rare tumours of the bladder: A Saudi registry based descriptive study. J Taibah Univ Med Sci 2022; 17:573-577. [PMID: 35983444 PMCID: PMC9356363 DOI: 10.1016/j.jtumed.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/02/2021] [Accepted: 12/04/2021] [Indexed: 11/30/2022] Open
Abstract
Objective There is limited literature focusing on the characteristics and behaviours of bladder tumours outside of the common three morphologies, that is, urothelial carcinoma, squamous cell carcinoma, and adenocarcinoma. The presented study provides a descriptive analysis of rare bladder tumours in KSA. Methods This retrospective cohort study included all patients with a primary rare bladder tumour between 1 January 2008 and 31 December 2017. The data were acquired from the Saudi Tumour Registry. Frequencies and percentages were then generated for the categorical variables, while means and standard deviations were calculated for quantitative variables. Results The study included 65 patients. The majority (n = 35, 53.8%) were aged 60 years and older. The patients were predominantly male (n = 53, 81.5%) and the majority lived in the Western region (n = 26, 40.?%). The most diagnosed tumour morphologies were small cell carcinoma in adults (n = 11, 16.9%) and embryonal rhabdomyosarcoma in children (n = 14, 21.5%), with the dominant diagnosis method being histology of primary tumour in 98.5% of the patients. Most tumours were localised (n = 30, 46.2%) and multifocal (n = 34, 52.3%). The overall mortality rate was 24.6%, with an overall diagnosis to death interval of 1.14 ± 0.75 years wherein small cell carcinoma was the shortest (0.84 ± 0.24) days. Conclusion There remains a gap in the literature regarding uncommon urologic tumours. Shedding light on these factors will aid in further understanding the patterns of tumour behaviour in the region. This will facilitate enhanced risk-and response-based screening strategies and more favourable outcomes. Additionally, formulating a global registry for such patients is recommended.
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Affiliation(s)
- Meshari A. Alqahtani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, KSA
- King Abdullah International Medical Research Center, Riyadh, KSA
| | - Mohammad A. Alghafees
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, KSA
- King Abdullah International Medical Research Center, Riyadh, KSA
- Corresponding address: College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Uzzam, AlManar, Riyadh, 14222, KSA.
| | - Ziyad F. Musalli
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, KSA
- King Abdullah International Medical Research Center, Riyadh, KSA
| | - Saud M. Alwatban
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, KSA
- King Abdullah International Medical Research Center, Riyadh, KSA
| | - Ahmed Alasker
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, KSA
- King Abdullah International Medical Research Center, Riyadh, KSA
- Department of Urology, King Abdulaziz Medical City, Riyadh, KSA
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Sui W, Hall ME, Barocas DA, Chang SS, Luckenbaugh AN, Moses KA, Penson DF, Wallis CJD, Laviana AA. Association Between Surgical Volume and Survival Among Patients With Variant Histologies of Bladder Cancer. Urology 2021; 159:100-106. [PMID: 34606878 DOI: 10.1016/j.urology.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/14/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine the relationship between hospital volume and the management of bladder cancer variant histology. Variant histologies of bladder cancer are rare which limits the ability for providers to develop expertise however there is a clear hospital and/or surgeon-volume relationship for management of rare or complex surgical and/or medical diseases. METHODS We queried the National Cancer Database from 2004-2016 for all cases of bladder cancer, identifying cases of variant histology. Our primary outcome was overall survival while secondary outcomes included identifying treatment patterns. Hospitals were stratified into those that managed ≤2, >2-4, >4-6, and ≥6 cases per year of variant histology. RESULTS We identified 23,284 patients with bladder cancer of variant histology who were treated at 1301 hospitals. Few institutions had high volume experience with this disease: 18.5% (n = 241) treated >2 patients annually and 5.7% (n = 76) treated >4 cases annually. Hospital volume positively correlated with utilization of early radical cystectomy (RC) in non-muscle invasive disease and neoadjuvant chemotherapy in muscle-invasive disease. On multivariable analysis, increased hospital volume was associated with improved survival. After stratifying by sub-type, hospital volume continued to be associated with improved survival for squamous, small cell, and sarcomatoid cancers. CONCLUSION Management of variant histology urothelial carcinoma at high-volume centers is associated with improved overall survival. The mechanisms of this are multifactorial, and future research should focus on improvement opportunities for low-volume hospitals, centralization of care, and/or increased access to care at high-volume centers.
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Affiliation(s)
- Wilson Sui
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Mary E Hall
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Daniel A Barocas
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Sam S Chang
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Amy N Luckenbaugh
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Kelvin A Moses
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - David F Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | | | - Aaron A Laviana
- Department of Surgery & Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX.
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Xu H, Genega EM, Zhuang L, Zhou M. High-grade Urothelial Carcinoma with Malignant Melanocytic Differentiation. Int J Surg Pathol 2021; 29:794-797. [PMID: 33733892 DOI: 10.1177/10668969211000428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Urothelial carcinoma usually shows divergent differentiation and variant histology with squamous and glandular morphology being most common. In this report, we present a case of divergent malignant melanocytic differentiation in a high-grade urothelial carcinoma. A 98-year-old East Asian woman with an anterior bladder wall mass underwent resection, which revealed a high-grade poorly differentiated tumor. A minor component of high-grade papillary urothelial carcinoma and carcinoma in situ is also present. The majority of the tumor cells are morphologically and immunohistochemically consistent with melanoma, a minority of cells are positive for urothelial markers, and rare cells coexpress both melanocytic and urothelial markers. Cells that express melanocytic markers or urothelial markers are intimately admixed together. Taken together, a diagnosis of high-grade urothelial carcinoma with malignant melanocytic differentiation was rendered. This is the first report in the literature of malignant melanocytic differentiation in a high-grade urothelial carcinoma, a finding that may have important diagnostic and therapeutic implications.
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Affiliation(s)
- Hongzhi Xu
- 1867Tufts Medical Center, Boston, MA, USA
| | | | | | - Ming Zhou
- 1867Tufts Medical Center, Boston, MA, USA
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4
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Sanguedolce F, Calò B, Mancini V, Zanelli M, Palicelli A, Zizzo M, Ascani S, Carrieri G, Cormio L. Non-Muscle Invasive Bladder Cancer with Variant Histology: Biological Features and Clinical Implications. Oncology 2021; 99:345-358. [PMID: 33735905 DOI: 10.1159/000514759] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 12/30/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The most common bladder cancer (BC) histotype is pure urothelial carcinoma (UC), which may undergo divergent differentiation in some cases. Variant histology (VH) presents along variable morphologies, either single or combined between them or with pure UC. From a clinical standpoint, the vast majority of BC is diagnosed at non-invasive or minimally invasive stages, namely as non-muscle invasive BC (NMIBC). There is a wide range of therapeutic options for patients with NMIBC, according to their clinical and pathological features. However, current risk stratification models do not show optimal effectiveness. Evidence from the literature suggests that VH has peculiar biological features, and may be associated with poorer survival outcomes compared to pure UC. SUMMARY In order to describe the biological features and prognostic/predictive role of VH in NMIBC, and to discuss current treatment options, we performed a systematic literature search through multiple databases (PubMed/Medline, Google Scholar) for relevant articles according to the following terms, single and/or in combination: "non-muscle invasive bladder cancer," "variant histology," "micropapillary variant," "glandular differentiation," "squamous differentiation," "nested variant," "plasmacytoid variant," and "sarcomatoid variant." We extracted 99 studies including original articles, reviews, and systematic reviews, and subsequently analyzed data from 16 studies reporting on the outcome of NMIBC with VH. We found that the relative rarity of these forms as well as the heterogeneity in study populations and therapeutic protocols results in conflicting findings overall. Key Messages: The presence of VH should be taken into account when counseling a patient with NMIBC, since it may upgrade the disease to high-risk tumor and thus warrant a more aggressive treatment.
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Affiliation(s)
| | - Beppe Calò
- Urology Unit, University of Foggia, Bonomo Teaching Hospital, Foggia, Italy
| | - Vito Mancini
- Urology and Renal Transplantation Unit, University of Foggia, Foggia, Italy
| | - Magda Zanelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Palicelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maurizio Zizzo
- Surgical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Ascani
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, Terni, Italy
| | - Giuseppe Carrieri
- Urology and Renal Transplantation Unit, University of Foggia, Foggia, Italy
| | - Luigi Cormio
- Urology Unit, University of Foggia, Bonomo Teaching Hospital, Foggia, Italy
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5
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Bandini M, Pederzoli F, Madison R, Briganti A, Ross JS, Niegisch G, Yu EY, Bamias A, Agarwal N, Sridhar SS, Rosenberg JE, Bellmunt J, Pal SK, Galsky MD, Lucianò R, Gallina A, Salonia A, Montorsi F, Ali SM, Chung JH, Necchi A. Unfavorable Cancer-specific Survival After Neoadjuvant Chemotherapy and Radical Cystectomy in Patients With Bladder Cancer and Squamous Cell Variant: A Multi-institutional Study. Clin Genitourin Cancer 2020; 18:e543-e556. [PMID: 32144050 PMCID: PMC8491463 DOI: 10.1016/j.clgc.2020.01.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 01/13/2020] [Accepted: 01/30/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Nonurothelial carcinoma (UC) malignancies have traditionally been considered to have a more aggressive clinical course, and little is known about their response to neoadjuvant therapy. We examined the effect of neoadjuvant chemotherapy (NAC) on a large population of patients with bladder cancer (BCa) with different histologic variants (HVs). PATIENTS AND METHODS We relied on a retrospective, multicenter database of 2858 patients with BCa who had undergone radical cystectomy with or without NAC from 1990 to 2017. Pure and mixed HVs were grouped into 6 categories: squamous cell carcinoma (SCC; n = 283; 45%), other subtypes (n = 95; 15%), micropapillary (n = 85; 14%), adenocarcinoma (n = 65; 10%), small cell (n = 54; 8.6%), and sarcomatous (n = 47; 7.6%). Kaplan-Meier and Cox regression analyses were used to examine cancer-specific survival (CSS) according to the HV, using pure UC as the reference. Logistic regression models were used to examine the odds of clinical-to-pathologic downstaging after NAC according to the HV. RESULTS Overall, we identified 2229 cases of pure UC and 629 cases of BCa with HVs at radical cystectomy. Of the 450 NAC-treated patients, only those patients with SCC (n = 44; 9.8%) had had worse CSS (median CSS, 33 vs. 116 months; P < .001) and higher mortality rates (hazard ratio, 2.1; P = .03) compared with those with pure UC (n = 328; 72.9%). The results of the analyses were also confirmed when the pure and mixed cases were considered separately. After adjusting for NAC, only SCC showed a lower rate of clinical-to-pathologic downstaging (odds ratio, 0.4; P = .03) compared with UC. CONCLUSIONS SCC was the HV exhibiting the lowest effect of NAC in terms of activity and CSS. Compared with pure UC, SCC seemed to be insensitive to traditional NAC regimens.
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Affiliation(s)
- Marco Bandini
- Urological Research Institute, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.
| | - Filippo Pederzoli
- Urological Research Institute, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Alberto Briganti
- Urological Research Institute, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Jeffrey S Ross
- Foundation Medicine, Cambridge, MA; Upstate Medical University, Syracuse, NY
| | - Günter Niegisch
- Department of Urology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Evan Y Yu
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
| | | | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake, UT
| | - Srikala S Sridhar
- Cancer Clinical Research Unit, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Joaquim Bellmunt
- Bladder Cancer Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | - Matthew D Galsky
- Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY
| | - Roberta Lucianò
- Department of Pathology, Ospedale San Raffaele, Milan, Italy
| | - Andrea Gallina
- Urological Research Institute, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Salonia
- Urological Research Institute, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Urological Research Institute, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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6
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Grant CM, Amdur R, Whalen MJ. Trends in the use of neoadjuvant chemotherapy for bladder cancer with nonurothelial variant histology: An analysis of the National Cancer Database. Indian J Urol 2019; 35:291-298. [PMID: 31619869 PMCID: PMC6792420 DOI: 10.4103/iju.iju_142_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction The aim of this study is to evaluate the trends in the use of neoadjuvant chemotherapy (NAC) over time (2006-2014) for patients diagnosed with muscle-invasive bladder cancer (MIBC) with nonurothelial variant histology (NUVH) in the National Cancer Database. Materials and Methods We queried the NCDB for patients with muscle-invasive (i.e. cT2-4N0-3M0/X) urothelial carcinoma (UC) of the bladder. We examined demographic, clinical, and pathologic features associated with NAC, also substratifying into pure UC and NUVH. Tests of association were performed using Chi-square/Fisher's exact test for categorical variables and t-tests, ANOVA, or Kruskal-Wallis test for continuous variables. Outcomes were examined with Cox proportional hazards and 90-day mortality with the Kaplan-Meier method. Results Totally 22,320 patients met our inclusion criteria, of whom 22.6% received NAC. The proportion of NAC increased significantly over time in the neuroendocrine and urothelial cell categories with 57.1% and 34.1% of patients in 2014 receiving NAC vs. 44% and 10.6% in 2006. No other variant histology showed a significant increase across the time sampled. Patients receiving NAC were more likely to have downstaging to pT0 (13.4% vs. 2.7%), negative surgical margin (89.1% vs. 86%), and pN0 (63.2% vs. 60.5%) and were less likely to have 30-day (1.4% vs. 3%) or 90-day (5% vs. 8.3%) mortality. Rates of downstaging to pT0 after NAC were similar among histologies. Conclusion Neoadjuvant chemotherapy utilization continues to slowly increase in patients with MIBC. Patients with variant histology lag behind in terms of receiving NAC but appear to derive as much benefit as patients with pure urothelial cell bladder cancer.
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Affiliation(s)
- Campbell M Grant
- Department of Urology, George Washington University Hospital, Washington, DC, USA
| | - Richard Amdur
- Department of Surgery, George Washington University Hospital, Washington, DC, USA
| | - Michael J Whalen
- Department of Urology, George Washington University Hospital, Washington, DC, USA
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7
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Yu J, Li G, Wang A, Luo Q, Liu Z, Niu Y, Mei Y. Impact of squamous differentiation on intravesical recurrence and prognosis of patients with upper tract urothelial carcinoma. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:377. [PMID: 31555691 DOI: 10.21037/atm.2019.07.31] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The prognostic role of squamous differentiation in upper urinary tract urothelial carcinoma (UTUC) is still unclear. This article describes the impact of squamous differentiation on prognosis and intravesical recurrence of patients with primary UTUC treated with radical nephroureterectomy (RNU). Methods Totally, we retrieved (I) 669 histologically confirmed UTUC patients without histologic variants; (II) 101 UTUC patients with squamous differentiation in our institution, dating from April 2003 to April 2016. The clinical pathological characteristics and survival outcomes were compared between these two cohorts. Results In our study, 13% UTUC patients were detected with squamous differentiation. The mean age of all the patients examined was 66, of whom 70% were males. Squamous differentiation significantly associated with tumor stage, tumor grade and lymphovascular invasion. The Kaplan-Meier and Cox regression analyses showed that presence of squamous differentiation was correlated with shorter cancer specific survival of UTUC patients. The 5-year cancer specific survival rates were 47% for squamous differentiation-present patients and 63% for squamous differentiation-absent patients. UTUC patients with squamous differentiation showed a higher frequency of high-grade disease in advanced stage (pT2/pT3/pT4), while the discrepancy was not shown in early stage (pTa/pT1). Intravesical recurrence was observed in 27% patients. We found that intravesical recurrence had little impact on the cancer specific survival of squamous differentiation-present patients, yet it tended to decrease cancer specific survival among squamous differentiation-absent patients. Conclusions The presence of squamous differentiation in UTUC patients was a vital prognostic factor for cancer specific survival and correlated with intravesical recurrence after receiving RNU.
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Affiliation(s)
- Jianpeng Yu
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin 300211, China
| | - Gang Li
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin 300211, China
| | - Aixiang Wang
- Department of Pathology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Qiang Luo
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin 300211, China
| | - Zihao Liu
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin 300211, China
| | - Yuanjie Niu
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin 300211, China
| | - Yanhui Mei
- Department of Urology, Binzhou Medical University Hospital, Binzhou 256603, China
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8
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Koguchi D, Matsumoto K, Ikeda M, Taoka Y, Hirayama T, Murakami Y, Utsunomiya T, Matsuda D, Okuno N, Irie A, Iwamura M. Histologic variants associated with biological aggressiveness and poor prognosis in patients treated with radical cystectomy. Jpn J Clin Oncol 2019; 49:373-378. [PMID: 30753532 DOI: 10.1093/jjco/hyz015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 01/07/2019] [Accepted: 01/17/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The prognostic value of histologic variants (HV) after radical cystectomy (RC) remains controversial. We evaluated the clinicopathological features and prognosis in patients with pure urothelial carcinoma (UC) and HV following RC. METHODS From 1990 to 2015, 286 patients with bladder cancer were treated with RC at six Kitasato University-affiliated hospitals. All patients were divided into two groups: pure UC and HV, which contained pure variants and mixed-type UC with variant pattern. A comparison of patient characteristics between the two groups was made to assess the clinicopathological features, and statistical analyses were performed to investigate prognosis in the two groups. RESULTS Of the 286 patients, 226 (79%) had pure UC, while 60 (21%) had HV. Of all HV, pure variants accounted for 45% (n = 27). The prevalence of lymph node involvement, locally advanced stage (≥ pT3), positive soft tissue surgical margin and lymphovascular invasion were significantly higher in patients with HV than in those with pure UC. Patients with HV showed worse disease-free survival and cancer-specific survival than those with pure UC (P = 0.009 and 0.003, respectively). In multivariate analysis, HV and lymph node involvement were independent predictors of worse disease-free survival (P = 0.017 and 0.001, respectively). HV, locally advanced stage, lymph node involvement, and positive soft tissue surgical margin were also confirmed as independent predictors of worse cancer-specific survival (P = 0.011, 0.012, 0.003 and 0.010, respectively.). CONCLUSIONS HV was associated with greater biological aggressiveness and worse prognosis than pure UC.
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Affiliation(s)
- Dai Koguchi
- Department of Urology, Kitasato University School of Medicine, Kanagawa 252-0374, Japan.,Department of Urology, Kitasato University Medical Center, Saitama 364-8501, Japan
| | - Kazumasa Matsumoto
- Department of Urology, Kitasato University School of Medicine, Kanagawa 252-0374, Japan
| | - Masaomi Ikeda
- Department of Urology, Kitasato University Kitasato Institute Hospital, Tokyo 108-8642, Japan
| | - Yoshinori Taoka
- Department of Urology, Kitasato University Medical Center, Saitama 364-8501, Japan
| | - Takahiro Hirayama
- Department of Urology, Kitasato University School of Medicine, Kanagawa 252-0374, Japan
| | - Yasukiyo Murakami
- Department of Urology, Kitasato University School of Medicine, Kanagawa 252-0374, Japan
| | - Takuji Utsunomiya
- Department of Urology, Kanagawa Prefectural Federation of Agricultural Cooperatives for Health and Welfare Sagamihara Kyodo Hospital, Kanagawa 252-5188, Japan
| | - Daisuke Matsuda
- Department of Urology, Higashiyamato Hospital, Tokyo 207-0014, Japan
| | - Norihiko Okuno
- Department of Urology, National Hospital Organization Sagamihara Hospital, Kanagawa 252-0392, Japan
| | - Akira Irie
- Department of Urology, Kitasato University Kitasato Institute Hospital, Tokyo 108-8642, Japan
| | - Masatsugu Iwamura
- Department of Urology, Kitasato University School of Medicine, Kanagawa 252-0374, Japan
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9
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Zhao G, Wang C, Tang Y, Liu X, Liu Z, Li G, Mei Y. Glandular differentiation in pT1 urothelial carcinoma of bladder predicts poor prognosis. Sci Rep 2019; 9:5323. [PMID: 30926888 PMCID: PMC6441090 DOI: 10.1038/s41598-019-41844-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/19/2019] [Indexed: 12/19/2022] Open
Abstract
To evaluate the effect of glandular differentiation (GD) on tumor recurrence and progression of pT1 bladder urothelial carcinoma (UC). We performed a retrospective analysis of 82 bladder urothelial carcinoma with glandular differentiation (UCGD) patients which was pathologically diagnosed as pT1, 166 patients of pT1 UC of bladder without histologic variants served as controls. Patients of UCGD were more likely to have higher recurrence (P = 0.002) rate and higher progression rate (P < 0.001). Moreover, UCGD and a poor 5 -year overall survival (OS) (P = 0.02) while there was no difference in cancer-specific survival (CSS) (P = 0.062) between two groups. According to univariate analysis, largest tumor size (HR 1.502, CI 1.158–1.861, P = 0.029), UCGD (HR 1.787, CI 1.298–2.552, P = 0.001), lymphovascular invasion (LVI) (HR 1.226, CI 1.013–1.945, P = 0.039). UCGD (HR 1.367, CI 1.115–1.853, P = 0.038) and LVI (HR 1.416, CI 1.120–2.254, P = 0.013) were prognostic factors associated with disease recurrence and progression, respectively. Additionally, Additionally, UCGD significantly influence disease recurrence (HR 1.871, CI 1.338–2.589, P < 0.001) and progression (HR 1.462, CI 1.138–2.393, p = 0.007). Similarly, LVI significantly influence disease recurrence (HR 1.356, CI 1.053–2.174, P = 0.042) and progression (HR 1.348, CI 1.052–1.944, p = 0.022) in multivariate analysis. UCGD is significantly associated with higher recurrence and progression rate in patients with newly diagnosed pT1. Recurrent cases should be performed radical cystectomy (RC) earlier.
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Affiliation(s)
- Guobin Zhao
- Department of Urology, The First Affiliated Hospital of Hebei North University, Zhangjiakou City, Hebei Province, 07500, China.
| | - Chao Wang
- Department of Urology, Fifth Central Hospital of Tianjin, Tianjin, 300450, China
| | - Yuhong Tang
- College of Laboratory Medicine, Hebei North University, Zhangjiakou City, Hebei Province, 07500, China
| | - Xin Liu
- Department of Urology, The First Affiliated Hospital of Hebei North University, Zhangjiakou City, Hebei Province, 07500, China
| | - Zihao Liu
- Department of Urology, Tianjin Institute of Urology, The second hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Gang Li
- Department of Urology, Tianjin Institute of Urology, The second hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Yanhui Mei
- Department of Urology, Binzhou Medical University Hospital, Binzhou, 256603, China
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10
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Davaro F, Schaefer J, May A, Raza J, Siddiqui S, Hamilton Z. Invasive non-urachal adenocarcinoma of the bladder: analysis of the National Cancer Database. World J Urol 2018; 37:497-505. [PMID: 30030660 DOI: 10.1007/s00345-018-2411-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 07/17/2018] [Indexed: 01/29/2023] Open
Abstract
PURPOSE To review the United States National Cancer Database (NCDB) from 2004 to 2015 and analyze survival outcomes of invasive non-urachal adenocarcinoma based on treatment modality. METHODS The NCDB 2004-2015 bladder dataset was queried for adenocarcinoma histology, excluding urachal variant, and limited to patients with clinical stage T2-T4 disease. Treatment modality was categorized as no treatment, cystectomy (partial or radical), external beam radiation therapy (EBRT), or EBRT plus cystectomy. Our primary outcome was overall survival. Cox regression (CR) and Kaplan-Meier (KM) analysis were performed. RESULTS 851 patients were identified with invasive (cT2-T4) adenocarcinoma of the bladder. Treatment modalities included 398 (47.8%) no treatment, 298 (35.8%) cystectomy, 124 (14.9%) EBRT, and 31 (3.7%) EBRT plus cystectomy. On KM analysis excluding those with metastatic disease, the 5-year survival was significantly better (p < 0.001) for patients who underwent cystectomy (39.6%), versus no treatment (21.0%), EBRT (18.6%), or EBRT plus cystectomy (26.9%) (log rank, p < 0.001). On CR for mortality, age (HR 1.030, p < 0.001), Charlson score 1 (HR 1.287, p = 0.034), cT4 (HR 1.768, p < 0.001), and receiving treatment at a low-volume center (HR 1.289, p = 0.026) were associated with worsened survival; however, cystectomy (HR 0.593, p < 0.001) was the only factor associated with improved survival. For those undergoing cystectomy, the mean length of stay was 8.5 days and the 30-day readmission rate was 7.0%. CONCLUSIONS Invasive non-urachal adenocarcinoma of the bladder is a rare diagnosis. Survival benefits in patients without metastatic disease are seen only in those patients undergoing definitive surgery.
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Affiliation(s)
- Facundo Davaro
- Division of Urology, Department of Surgery, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO, 63110, USA
| | - Jared Schaefer
- Division of Urology, Department of Surgery, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO, 63110, USA
| | - Allison May
- Division of Urology, Department of Surgery, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO, 63110, USA
| | - Johar Raza
- Division of Urology, Department of Surgery, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO, 63110, USA
| | - Sameer Siddiqui
- Division of Urology, Department of Surgery, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO, 63110, USA
| | - Zachary Hamilton
- Division of Urology, Department of Surgery, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO, 63110, USA.
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11
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Liu Y, Bui MM, Xu B. Urothelial Carcinoma with Squamous Differentiation is Associated with High Tumor Stage and Pelvic Lymph-Node Metastasis. Cancer Control 2018; 24:78-82. [DOI: 10.1177/107327481702400113] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Yunguang Liu
- Department of Pathology and Laboratory Medicine, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Roswell Park Cancer Institute, Buffalo, New York, Cytopathology Fellowship Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Indian River Medical Center, Vero Beach, Florida
| | - Marilyn M. Bui
- University of South Florida Morsani College of Medicine, Tampa, Florida, and the Department of Anatomic Pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Bo Xu
- Department of Pathology and Laboratory Medicine, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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12
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Li G, Yu J, Song H, Zhu S, Sun L, Shang Z, Niu Y. Squamous differentiation in patients with superficial bladder urothelial carcinoma is associated with high risk of recurrence and poor survival. BMC Cancer 2017; 17:530. [PMID: 28789622 PMCID: PMC5549361 DOI: 10.1186/s12885-017-3520-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 08/01/2017] [Indexed: 12/05/2022] Open
Abstract
Background The independent prognostic role of squamous differentiation in pT1 bladder urothelial carcinoma has not been reported in previous studies. This article describes the impact of squamous differentiation on tumor recurrence and survival, and whether this histologic variant could indeed alter definitive treatment, based on single center-based retrospective data. Methods Totally, we retrieved (1)1449 histologically confirmed pT1 bladder urothelial carcinoma patients without histologic variants; (2)227 pT1 bladder urothelial carcinoma patients with squamous differentiation in our institution, from May 2004 to Oct 2015. The total amount of high/low grade urothelial carcinoma patients was 991/685 respectively. Transurethral resection of bladder tumor (TURBT) and intravesical chemotherapy were performed as initial treatments for all the patients. The clinical and pathological characteristics, treatment and survival outcomes were compared between squamous differentiation-positive and squamous differentiation-negative patients. Results In our study, 14% urothelial carcinoma patients were detected with squamous differentiation. The mean age of all the patients examined was 66.4, of whom 82% were males. The 5-year cancer specific survival rates were 69% for squamous differentiation-positive patients and 91% for squamous differentiation-negative patients (p < 0.001). Recurrence proved to be more common in squamous differentiation-positive patients than in negative patients. In the results of the univariate and multivariate Cox proportional hazard analysis, tumor size, lymphovascular invasion, recurrence and squamous differentiation were confirmed to be the prognostic factors associated with patients’ survival. Conclusions Squamous differentiation in pT1 bladder urothelial carcinoma is correlated to high risk of recurrence and poor prognosis as an independent prognostic factor. Radical cystectomy is essential for recurred high grade pT1 bladder urothelial carcinoma with squamous differentiation accompanied by lymphovascular invasion.
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Affiliation(s)
- Gang Li
- Department of Urology, Tianjin Institute of Urology, The second hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Jianpeng Yu
- Department of Urology, Tianjin Institute of Urology, The second hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Hualin Song
- Department of Urology, Tianjin Institute of Urology, The second hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Shimiao Zhu
- Department of Urology, Tianjin Institute of Urology, The second hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Libin Sun
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Zhiqun Shang
- Department of Urology, Tianjin Institute of Urology, The second hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Yuanjie Niu
- Department of Urology, Tianjin Institute of Urology, The second hospital of Tianjin Medical University, Tianjin, 300211, China.
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13
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Vetterlein MW, Wankowicz SAM, Seisen T, Lander R, Löppenberg B, Chun FKH, Menon M, Sun M, Barletta JA, Choueiri TK, Bellmunt J, Trinh QD, Preston MA. Neoadjuvant chemotherapy prior to radical cystectomy for muscle-invasive bladder cancer with variant histology. Cancer 2017; 123:4346-4355. [DOI: 10.1002/cncr.30907] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/30/2017] [Accepted: 07/05/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Malte W. Vetterlein
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
- Department of Urology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Stephanie A. M. Wankowicz
- Lank Center for Genitourinary Oncology; Dana-Farber Cancer Institute, Harvard Medical School; Boston Massachusetts
| | - Thomas Seisen
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
- Department of Urology; Pitié-Salpêtriére Hospital, Pierre and Marie Curie University; Paris France
| | - Richard Lander
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Björn Löppenberg
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
- Department of Urology; Marien Hospital Herne, Ruhr-University Bochum; Herne Germany
| | - Felix K.-H. Chun
- Department of Urology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Mani Menon
- Center for Outcomes Research; Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System; Detroit Michigan
| | - Maxine Sun
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Justine A. Barletta
- Department of Pathology; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Toni K. Choueiri
- Lank Center for Genitourinary Oncology; Dana-Farber Cancer Institute, Harvard Medical School; Boston Massachusetts
| | - Joaquim Bellmunt
- Lank Center for Genitourinary Oncology; Dana-Farber Cancer Institute, Harvard Medical School; Boston Massachusetts
| | - Quoc-Dien Trinh
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Mark A. Preston
- Division of Urological Surgery; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
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14
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Xu H, Xie L, Liu X, Zhang Y, Shen Z, Chen T, Qiu X, Sha N, Xing C, Wu Z, Hu H, Wu C. Impact of squamous and/or glandular differentiation on recurrence and progression following transurethral resection for non-muscle invasive urothelial carcinoma of bladder. Oncol Lett 2017; 14:3522-3528. [PMID: 28927108 PMCID: PMC5587993 DOI: 10.3892/ol.2017.6581] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 03/03/2017] [Indexed: 11/08/2022] Open
Abstract
The aim of the present study was to investigate the impact of squamous and/or glandular differentiation on the recurrence and progression in patients with nonmuscle invasive urothelial carcinoma of bladder (NMIUCB) following transurethral resection (TURBT). A total of 869 patients with NMIUCB who had been treated with TURBT at The Second Hospital of Tianjin Medical University (Tianjin, China) between January 2006 and January 2011 were retrospectively selected for the present analysis. Associations among squamous and/or glandular differentiation with other clinical and pathological features were assessed by the χ2 test. Recurrence-free survival (RFS) and progression-free survival (PFS) curves were estimated using the Kaplan-Meier method. Univariate and multivariate analyses were performed through a Cox's proportional hazards regression model. Among the 869 patients, 232 (26.7%) patients had squamous and/or glandular differentiation. High grade tumors were more common in patients with squamous and/or glandular differentiation compared with those with pure urothelial carcinoma of bladder (P<0.001). Associations between age (P=0.115), sex (P=0.184), tumor size (P=0.223), tumor multiplicity (P=0.108), pathological tumor stage (P=0.909) and squamous and/or glandular differentiation were not observed to be statistically significant. There was a significant tendency towards higher recurrence rate and shorter RFS time in patients with squamous and/or glandular differentiation. However, no statistically significant differences were observed in progression rate and PFS between the two groups. The multivariate Cox regression analysis, identified squamous and/or glandular differentiation as an independent prognostic predictor of recurrence (hazard ratio =1.46, 95% confidence interval=1.10–1.92, P=0.008). In the present study, the presence of squamous and/or glandular differentiation was associated with a higher recurrence rate and shorter RFS time in patients with NMIUCB. Squamous and/or glandular differentiation is therefore an independent prognostic predictor of recurrence.
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Affiliation(s)
- Hao Xu
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
| | - Linguo Xie
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
| | - Xiaoteng Liu
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
| | - Yu Zhang
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
| | - Zhonghua Shen
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
| | - Tao Chen
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
| | - Xiaoyu Qiu
- College of Management and Economics, Tianjin University, Nankai, Tianjin 300072, P.R. China
| | - Nan Sha
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
| | - Chen Xing
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
| | - Zhouliang Wu
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
| | - Hailong Hu
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
| | - Changli Wu
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
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15
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Vlachostergios PJ, Jakubowski C, Tagawa ST. Trimodality therapy in variant urothelial carcinoma: choose wisely. Transl Androl Urol 2017; 6:322-325. [PMID: 28540247 PMCID: PMC5422701 DOI: 10.21037/tau.2017.03.59] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
| | | | - Scott T Tagawa
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY, USA.,Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA.,Department of Urology, Weill Cornell Medicine, New York, NY, USA
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16
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Zhang X, Zhang M, Hou Y, Xu L, Li W, Zou Z, Liu C, Xu A, Wu S. Single-cell analyses of transcriptional heterogeneity in squamous cell carcinoma of urinary bladder. Oncotarget 2016; 7:66069-66076. [PMID: 27602771 PMCID: PMC5323215 DOI: 10.18632/oncotarget.11803] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 08/10/2016] [Indexed: 12/13/2022] Open
Abstract
Cell-to-cell expression heterogeneity within a single tumor is a common phenotype among various cancer types including squamous cell carcinoma. To further study the fundamentals and importance of heterogeneity of cell functions and its potential mechanisms, we performed single-cell RNA-seq (scRNA-seq) on human squamous cell carcinoma of the bladder (SCCB) and its corresponding physiologically normal epithelia. Extensive differentially expressed genes were uncovered by comparing cancer and normal single cells, which were preferentially enriched in cancer-correlated pathways, such as p53 signaling and bladder cancer pathway. Furthermore, the most diversely expressed genes were particularly enriched in MAPK signaling pathway, such as CACNG4, CACNA1E and CACNA1H, which involve in cancer evolution and heterogeneity formation. Co-expression network and hub-gene analyses revealed several remarkable "hub genes" of each regulatory module. Some of them are cancer related, such as POU2F3, NKD1 and CYP2C8, while LINC00189, GCC2 and OR9Q1 genes are rarely reported in human diseases. The genes within an interesting module are highly correlated with others, which could be treated as potential targets for SCCB patients. Our findings have fundamental implications for SCCB biology and therapeutic strategies.
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Affiliation(s)
- Xiaolong Zhang
- Department of Urological Surgery, The Affiliated Luohu Hospital of Shenzhen University, Shenzhen University, Shenzhen, China
- Shenzhen Following Precision Medical Institute, Shenzhen Luohu Hospital Group, Shenzhen, China
- Shenzhen Gene Detection Public Service Platform of Clinical Application, Shenzhen Luohu Hospital Group, Shenzhen, China
| | - Meng Zhang
- Department of Urological Surgery, The Affiliated Luohu Hospital of Shenzhen University, Shenzhen University, Shenzhen, China
- Shenzhen Following Precision Medical Institute, Shenzhen Luohu Hospital Group, Shenzhen, China
- Shenzhen Gene Detection Public Service Platform of Clinical Application, Shenzhen Luohu Hospital Group, Shenzhen, China
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | | | | | - Weidong Li
- Department of Urological Surgery, The Affiliated Luohu Hospital of Shenzhen University, Shenzhen University, Shenzhen, China
| | - Zhihui Zou
- Department of Urology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Chunxiao Liu
- Department of Urology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Abai Xu
- Department of Urology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Song Wu
- Department of Urological Surgery, The Affiliated Luohu Hospital of Shenzhen University, Shenzhen University, Shenzhen, China
- Shenzhen Following Precision Medical Institute, Shenzhen Luohu Hospital Group, Shenzhen, China
- Shenzhen Gene Detection Public Service Platform of Clinical Application, Shenzhen Luohu Hospital Group, Shenzhen, China
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17
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Jóźwicki W, Brożyna AA, Siekiera J, Slominski AT. Frequency of CD4+CD25+Foxp3+ cells in peripheral blood in relation to urinary bladder cancer malignancy indicators before and after surgical removal. Oncotarget 2016; 7:11450-62. [PMID: 26862849 PMCID: PMC4905485 DOI: 10.18632/oncotarget.7199] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 01/12/2016] [Indexed: 01/09/2023] Open
Abstract
Tumor cells communicate with stromal cells, including cancer-associated fibroblasts (CAFs) and tumor-associated macrophages (TAMs), to form microenvironment inhibiting immune responses. Regulatory T cells (Tregs, CD4+CD25+FoxP3+) stimulate immune tolerance and facilitate tumor progression. We analyzed the changes in Treg frequencies assessed using flow cytometry in the peripheral blood of patients with urothelial bladder cancer before and after tumor-removal. Changes in Treg frequency were investigated in relation to clinicopathomorphological indicators of tumor malignancy and expression of RCAS1 on CAFs and TAMs. Higher Treg frequencies were observed in early phase of tumor growth (pTa-pT2), in larger tumors, with more aggressive type of invasion, and with expression of RCAS1. The later phase of tumor development, accompanied by a nonclassic differentiations and pT3-pT4 advancement, had lower number of tumor infiltrating lymphocytes (TILs) and lower Treg frequency. Furthermore, in pT2-pT4 tumors, a decreased post-surgery Treg frequency was associated with poorer prognosis: patients with the lowest frequency of Tregs died first. These findings strongly suggest that the Treg frequencies at later phase of tumor growth, associated with a low anti-tumor response, represent a new and important prognostic indicator in urinary bladder cancer.
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Affiliation(s)
- Wojciech Jóźwicki
- Department of Tumour Pathology and Pathomorphology, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz, Bydgoszcz 85-796, Poland
- Department of Tumour Pathology and Pathomorphology, Oncology Centre-Prof. Franciszek Łukaszczyk Memorial Hospital, Bydgoszcz 85-796, Poland
| | - Anna A. Brożyna
- Department of Tumour Pathology and Pathomorphology, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz, Bydgoszcz 85-796, Poland
- Department of Tumour Pathology and Pathomorphology, Oncology Centre-Prof. Franciszek Łukaszczyk Memorial Hospital, Bydgoszcz 85-796, Poland
| | - Jerzy Siekiera
- Department of Urology, Oncology Centre-Prof. Franciszek Łukaszczyk Memorial Hospital, Bydgoszcz 85-796, Poland
| | - Andrzej T. Slominski
- Departments of Dermatology and Pathology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
- VA Medical Center, Birmingham, AL 35233, USA
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18
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Jóźwicki W, Brożyna AA, Siekiera J, Slominski AT. Changes in Immunogenicity during the Development of Urinary Bladder Cancer: A Preliminary Study. Int J Mol Sci 2016; 17:285. [PMID: 26927070 PMCID: PMC4813149 DOI: 10.3390/ijms17030285] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 02/06/2016] [Accepted: 02/14/2016] [Indexed: 12/28/2022] Open
Abstract
In the present study, we evaluated tumor-infiltrating lymphocytes (TILs) and blood regulatory T lymphocyte (Tregs, CD4+/CD25+/FoxP3+) expression in bladder cancer patients. The number of CD4+, CD8+, CD25+, FoxP3+ and CD20+ TILs was analyzed in association with clinico-pathomorphological features. In more advanced metastasizing tumors, showing non-classic differentiation (ND) and a more aggressive tissue invasion type (TIT), the number of TILs decreased. A low number of CD4+ TILs was associated with poor prognosis. Similarly, Treg frequency before surgery and after surgical treatment was significantly lower in more advanced tumors. The changes in TILs, as well as of local and systemic Tregs, were accompanied by changes in the histological phenotype of urothelial carcinoma regarding pT stage, NDs, TIT, and clinical outcomes. The number of TILs and the frequency of blood Tregs (indicators of antitumor response) may be essential for choosing an immunotherapy that is adjusted to the immune status according to the phase of tumor growth. Moreover, a significant reduction in the number of CD4+ and CD8+ TILs with the development of NDs in more advanced tumors may be associated with lower tumor immunogenicity, resulting in immune tolerance towards tumor tissue. These observations and the tendency of urothelial bladder carcinoma to undergo NDs in a heterogeneous manner during tumor progression suggest complex interactions between bladder cancer immunogenicity and stages of tumor progression.
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Affiliation(s)
- Wojciech Jóźwicki
- Department of Tumour Pathology and Pathomorphology, Faculty of Health Sciences, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz, Romanowska Street 2, Bydgoszcz 85-796, Poland.
- Department of Tumour Pathology and Pathomorphology, Oncology Centre-Prof. Franciszek Łukaszczyk Memorial Hospital, Romanowska Street 2, Bydgoszcz 85-796, Poland.
| | - Anna A Brożyna
- Department of Tumour Pathology and Pathomorphology, Faculty of Health Sciences, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz, Romanowska Street 2, Bydgoszcz 85-796, Poland.
- Department of Tumour Pathology and Pathomorphology, Oncology Centre-Prof. Franciszek Łukaszczyk Memorial Hospital, Romanowska Street 2, Bydgoszcz 85-796, Poland.
| | - Jerzy Siekiera
- Department of Urology, Oncology Centre-Prof. Franciszek Łukaszczyk Memorial Hospital, Romanowska Street 2, Bydgoszcz 85-796, Poland.
| | - Andrzej T Slominski
- Departments of Dermatology and Pathology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
- Laboratory Service of the VA Medical Center, 700 South 19th Street, Birmingham, AL 35233, USA.
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19
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Gellert LL, Warrick J, Al-Ahmadie HA. Urothelial carcinoma with squamous differentiation--the pathologists׳ perspective. Urol Oncol 2015; 33:437-43. [PMID: 26321057 DOI: 10.1016/j.urolonc.2015.07.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 06/29/2015] [Accepted: 07/26/2015] [Indexed: 11/25/2022]
Abstract
Squamous differentiation is the most common variant histology in urothelial carcinoma and may have effects on clinical outcome. Inconsistencies in reporting variant histologies in urothelial carcinoma are well documented. Immunohistochemical and molecular markers may help identify tumors with squamous differentiation beyond light microscopy.
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Affiliation(s)
- Lan L Gellert
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN
| | - Joshua Warrick
- Department of Pathology, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Hikmat A Al-Ahmadie
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY.
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20
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Izard JP, Siemens DR, Mackillop WJ, Wei X, Leveridge MJ, Berman DM, Peng Y, Booth CM. Outcomes of squamous histology in bladder cancer: a population-based study. Urol Oncol 2015. [PMID: 26199176 DOI: 10.1016/j.urolonc.2015.06.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Squamous cell carcinoma (SCC) of the bladder is an uncommon form of bladder cancer. Using a large population-based sample we sought to describe the outcomes of patients with squamous histology and to define the factors that influence prognosis in these patients. METHODS All incident cases of bladder cancer in Ontario undergoing cystectomy from 1994 to 2008 were identified. Electronic treatment records and detailed pathologic information were linked to the study data set. Patients were divided into 3 cohorts: pure SCC, urothelial carcinoma (UC) with squamous differentiation (UCSD), and pure UC. Cox modeling was performed to evaluate factors associated with overall survival (OS) and cancer-specific survival (CSS). RESULTS There were identified 178, 325, and 2,884 cases of SCC, UCSD, and UC, respectively. The unadjusted 5-year OS for these groups were 33%, 28%, and 34%, respectively. Patients had higher rates of T3/4 disease with SCC (72%) and UCSD (73%) than those with UC (61%, P<0.001). There was no difference in node positivity among groups (20%, 27%, and 25%, P = 0.519). After adjusting for covariates, SCC did not portend a worse survival, at 5 years. However, SCC did result in a more rapid disease trajectory, with survival curves of SCC and UC crossing at the 5-year mark. Adjusted CSS/OS of UCSD was also not significantly different from UC. Among those patients with SCC, factors associated with CSS included age>70 (hazard ratio [HR] = 1.96, 95% CI: 1.16-3.30), T category≥3 (HR = 2.09, 95% CI: 1.24-3.50), N positive disease (HR = 2.59, 95% CI: 1.55-4.32), lymphovascular invasion (HR = 1.98, 95% CI: 1.13-3.47), and positive surgical margins (HR = 2.95, 95% CI: 1.47-5.93). CONCLUSIONS After adjusting for patient and disease characteristics, we have found that SCC leads to a more rapid disease course with survival that is equivalent to UC by 5 years.
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Affiliation(s)
- Jason P Izard
- Department of Urology, Queen's University, Kingston, Canada; Department of Oncology, Queen's University, Kingston, Canada; Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Canada.
| | - D Robert Siemens
- Department of Urology, Queen's University, Kingston, Canada; Department of Oncology, Queen's University, Kingston, Canada; Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Canada
| | - William J Mackillop
- Department of Oncology, Queen's University, Kingston, Canada; Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Canada; Department of Public Health Sciences, Queen's University, Kingston, Canada
| | - Xuejiao Wei
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Canada
| | - Michael J Leveridge
- Department of Urology, Queen's University, Kingston, Canada; Department of Oncology, Queen's University, Kingston, Canada
| | - David M Berman
- Department of Oncology, Queen's University, Kingston, Canada; Department of Pathology, Queen's University, Kingston, Canada
| | - Yingwei Peng
- Department of Public Health Sciences, Queen's University, Kingston, Canada; Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Canada
| | - Christopher M Booth
- Department of Oncology, Queen's University, Kingston, Canada; Department of Public Health Sciences, Queen's University, Kingston, Canada; Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Canada
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Ge P, Wang ZC, Yu X, Lin J, He Q. Sensitivity of initial biopsy or transurethral resection of bladder tumor(s) for detecting histological variants on radical cystectomy. BMC Urol 2015; 15:46. [PMID: 26025446 PMCID: PMC4448304 DOI: 10.1186/s12894-015-0037-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 05/14/2015] [Indexed: 11/29/2022] Open
Abstract
Background To investigate the efficacy of initial biopsy or transurethral resection of bladder tumor for detecting histological variants on radical cystectomy and to assess the prognostic significance of variant histology on urothelial carcinoma outcomes after radical cystectomy. Methods Clinical and histopathological characteristics of 147 patients with variant histology who underwent radical cystectomy for urothelial carcinoma between 2006 and 2012 were assessed. Sensitivity was calculated as the proportion of radical cystectomy specimens with a particular variant that also presented the variant in the biopsy or transurethral resection specimen. The Kaplan-Meier method and multivariate Cox proportional hazard regression analysis were used to estimate cancer-specific survival. Results Of the 147 patients, 116 (79 %) were diagnosed with a single variant histology, and 31 (21 %) had multiple patterns. Squamous differentiation (31 %) was the most common single variant histology, followed by glandular differentiation (28 %). Except for small cell variant (100 %), the sensitivity of biopsy and transurethral resection was most effective for the diagnosis of squamous differentiation, 19 % vs. 40 % respectively, followed by glandular differentiation, 11 % vs. 21 % respectively. A total of 6 % and 49 % patients could be variant-free partially due to biopsy or complete resection(s) respectively. Presence of variant differentiation in urothelial carcinoma at cystectomy was significantly associated with inferior survival both in univariate analysis (P = 0.005) and multivariate analysis (HR4.48, 95 % CI:1.03-19.53). Conclusions Overall sensitivity of biopsy or transurethral resection to detect variant differentiation on cystectomy is relatively low. Patients with variant differentiation on cystectomy specimens have inferior survival.
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Affiliation(s)
- Peng Ge
- Department of Urology, Peking University First Hospital and Institute of Urology, Peking University, Beijing, 100034, China. .,National Research Center for Genitourinary Oncology, Beijing, 100034, China.
| | - Zi-Cheng Wang
- Department of Urology, Peking University First Hospital and Institute of Urology, Peking University, Beijing, 100034, China. .,National Research Center for Genitourinary Oncology, Beijing, 100034, China.
| | - Xi Yu
- Department of Urology, Peking University First Hospital and Institute of Urology, Peking University, Beijing, 100034, China. .,National Research Center for Genitourinary Oncology, Beijing, 100034, China.
| | - Jian Lin
- Department of Urology, Peking University First Hospital and Institute of Urology, Peking University, Beijing, 100034, China. .,National Research Center for Genitourinary Oncology, Beijing, 100034, China.
| | - Qun He
- Department of Urology, Peking University First Hospital and Institute of Urology, Peking University, Beijing, 100034, China. .,National Research Center for Genitourinary Oncology, Beijing, 100034, China.
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Gaisa NT, Wilms H, Wild PJ, Jakse G, Heidenreich A, Knuechel R. In cystectomy specimens with bladder cancer whole organ embedding increases the detection rate of histopathological parameters, but not of those with prognostic significance. Virchows Arch 2015; 466:423-32. [PMID: 25677977 DOI: 10.1007/s00428-015-1726-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 10/23/2014] [Accepted: 01/22/2015] [Indexed: 10/24/2022]
Abstract
Histological tumor subtyping, staging, and grading are of utmost importance to stratify patients with bladder cancer for treatment and should be as precise as possible. In the presented study, we investigated the prognostic impact of standard clinicopathological parameters in cystectomy patients and compared embedding of the entire bladder with standard partial embedding via a virtual superimposed approach. The study included 121 cystectomy specimens, which were completely embedded. Clinical and histopathological data of patients were obtained (median follow-up 21.5 months; range 1-67 months). For 88 patients two-dimensional tumor maps (macrophotographs and histology-based maps) were prepared, and embedding of the entire bladder was compared with a virtual standard partial embedding, created by a virtual overlay and data extraction of the tumor maps. Kaplan-Meier plots, Cox regression estimators, Chi-square, and McNemar tests were used. In a multivariate Cox regression model for overall survival, only venous invasion (p = 0.008, HR = 3.35, 95 % CI 1.375-8.161) and organ-confined (pTis-pT2) versus non-organ-confined diseases (pT3-pT4; p = 0.021, HR 2.669, 95 % CI 1.157-6.159) were found significant. Advanced versus standard embedding revealed significant improvement in the detection of carcinoma in situ (50 versus 61, p = 0.003) and lymphatic invasion (18 versus 24, p = 0.041), but no significant advantage in the detection of tumor stage, tumor multifocality, or venous invasion (all p > 0.05). TNM classification, including lymphatic and venous invasion, is of utmost importance to stratify patients with advanced invasive bladder cancer. Histopathological details are detected more reliably by whole organ embedding, but this approach showed no significant benefit in terms of outcome-related parameters (max. tumor stage, venous invasion) in our cohort.
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Affiliation(s)
- Nadine T Gaisa
- Institute of Pathology, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
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Jóźwicki W, Brożyna AA, Siekiera J, Slominski AT. Expression of RCAS1 correlates with urothelial bladder cancer malignancy. Int J Mol Sci 2015; 16:3783-803. [PMID: 25674852 PMCID: PMC4346926 DOI: 10.3390/ijms16023783] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 02/02/2015] [Indexed: 01/09/2023] Open
Abstract
RCAS1 is a protein that participates in regulation of the tumor microenvironment and its immune responses, all in order to evade the immune system. The aim of this study was to analyze RCAS1 expression in urothelial bladder cancer cells (and in fibroblasts and macrophages of the tumor stroma) and its relationship with the histological pattern of malignancy. Eighty-three postcystectomy patients were enrolled. We analyzed the histological maturity (grade), progress (pT stage), tissue invasion type (TIT), nonclassic differentiation number (NDN), and the ability to metastasize (pN). The expression of RCAS1 protein was analyzed by immunohistochemistry. Indicators of histological malignancy were observed solely in association with the RCAS1 expression in cells in the border parts (BPs) of the tumor. Histological malignancy of the tumor, indicated by the pT and pN, and metastasis-free survival time, correlated significantly with RCAS1 expression in tumor neoplastic cells, whereas malignancy determined by grade, TIT, and NDN correlated with RCAS1 expression in fibroblasts and macrophages in the tumor microenvironment. These findings suggest that the increased RCAS1 expression depends on its cellular source and that RCAS1 expression itself is a component of various signaling pathways. The immune escape occurs within the tumor BPs, where the increase in the RCAS1 expression occurs within tumor cells and stromal cells in its microenvironment. We conclude that the histological pattern of tumor malignancy, indicated by grade, TIT, NDN, pT, and pN is a morphological indicator of immune escape.
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Affiliation(s)
- Wojciech Jóźwicki
- Department of Tumor Pathology and Pathomorphology, the Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Romanowska Street 2, Bydgoszcz 85-796, Poland.
- Department of Tumor Pathology and Pathomorphology, the Franciszek Łukaszczyk Oncology Centre, Romanowska Street 2, Bydgoszcz 85-796, Poland.
| | - Anna A Brożyna
- Department of Tumor Pathology and Pathomorphology, the Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Romanowska Street 2, Bydgoszcz 85-796, Poland.
- Department of Tumor Pathology and Pathomorphology, the Franciszek Łukaszczyk Oncology Centre, Romanowska Street 2, Bydgoszcz 85-796, Poland.
| | - Jerzy Siekiera
- Department of Urology, the Franciszek Łukaszczyk Oncology Centre, Romanowska Street 2, Bydgoszcz 85-796, Poland.
| | - Andrzej T Slominski
- Department of Pathology and Laboratory Medicine, University of Tennessee HSC, 930 Madison Avenue, Memphis, TN 38163, USA.
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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Soave A, Schmidt S, Dahlem R, Minner S, Engel O, Kluth LA, John LM, Hansen J, Schmid M, Sauter G, Shariat SF, Fisch M, Rink M. Does the extent of variant histology affect oncological outcomes in patients with urothelial carcinoma of the bladder treated with radical cystectomy? Urol Oncol 2015; 33:21.e1-21.e9. [DOI: 10.1016/j.urolonc.2014.10.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 10/22/2014] [Accepted: 10/22/2014] [Indexed: 10/24/2022]
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Expression of OCT4A: the first step to the next stage of urothelial bladder cancer progression. Int J Mol Sci 2014; 15:16069-82. [PMID: 25216339 PMCID: PMC4200762 DOI: 10.3390/ijms150916069] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 09/02/2014] [Accepted: 09/03/2014] [Indexed: 12/20/2022] Open
Abstract
OCT4 (octamer-binding transcription factor) is a transcription factor responsible for maintaining the pluripotent properties of embryonic stem cells. In this paper, we present the results of studies to investigate the role of the OCT4 splicing variant in urothelial bladder cancer and the relationship between the OCT4 phenotype and the morphological parameters of tumor malignancy. Ninety patients who received a cystectomy for bladder cancer were enrolled. The expression of OCT4 protein was analyzed by immunohistochemistry. The ratio of OCT4-positive cells was the lowest in pT1 (pathological assessment (p)--tumor extent confined to mucosa (T1)) tumors and the highest in pTis (non-papillary tumor extent confined to urothelium) and pT2 (tumor extent including muscularis propria) tumors. Information about the percentage of OCT4A-positive tumor cells could facilitate choosing the treatment mode in borderline pTis-pT1 (crossing the border of the basement membrane; the first stage of progression) and pT1-pT2 (crossing the border of the muscularis propria; the second stage of progression) cases: a higher percentage of OCT4A-positive cells should support more radical therapy. A significantly higher percentage of cases with moderate OCT4 intensity was found in metastasizing (the third stage of progression) cases with >2 positive lymph nodes. The percentage of OCT4-positive cells was significantly higher for cancers with a high grade, higher non-classic differentiation number and greater aggressiveness of invasion. The differentiation, maturation and aggressiveness of tumor invasion appear to depend on the expression of the OCT4 phenotype in cancer cells, similar to the successive stages of malignancy progression in urothelial cancer.
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27
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Impact of histological variants on the outcomes of nonmuscle invasive bladder cancer after transurethral resection. Curr Opin Urol 2014; 24:524-31. [DOI: 10.1097/mou.0000000000000086] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Mitra AP, Bartsch CC, Bartsch G, Miranda G, Skinner EC, Daneshmand S. Does presence of squamous and glandular differentiation in urothelial carcinoma of the bladder at cystectomy portend poor prognosis? An intensive case-control analysis. Urol Oncol 2013; 32:117-27. [PMID: 23477878 DOI: 10.1016/j.urolonc.2012.08.017] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 08/15/2012] [Accepted: 08/15/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The prognostic significance of squamous and glandular elements, the most common histologic variants of urothelial carcinoma of the bladder (UCB), is unclear. This study aimed to examine the sole influence of squamous or glandular or both differentiation on UCB outcome following cystectomy and to identify factors that explain the relatively poor prognosis observed in UCB patients with these differentiation elements. MATERIALS AND METHODS A total of 2,444 patients who underwent radical cystectomy with extended lymph node dissection at a single referral center between 1976 and 2008 were considered. We identified 141, 97, and 21 patients with squamous, glandular, and squamous + glandular differentiation elements, respectively ("cases"). Pure UCB patients without differentiation were matched 1:1 to these cases for demographic, tumor, and treatment characteristics ("controls"). Cases were also compared with an independent cohort of 1,244 pure UCB controls. Recurrence-free and overall survivals were compared between cohorts using univariable and multivariable Cox proportional hazards analyses. RESULTS Median follow-up for cases, controls, and independent control cohort was 15.2, 11.0, and 12.2 years, respectively. Cases were matched to controls for pathologic stage (chi-square P = 1.00) and administration of intravesical agents (P≥0.85), neoadjuvant (P≥0.31), and adjuvant (P≥0.96) chemotherapy. Cases were also balanced with controls for age, gender, and race (P≥0.30). Following this intensive matching, no differences in outcomes between cases and controls were observed (log-rank P≥0.12). Pathologic stage was predictive of outcome in cases with differentiation by multivariable analysis (P≤0.004). When compared to an independent control cohort, cases with differentiation were observed to present with higher pathologic stage at cystectomy (chi-square P≤0.005). CONCLUSIONS Outcomes of UCB patients with squamous or glandular or both differentiation are similar to those of patients with pure UCB, given comparable demographic, clinicopathologic, and management characteristics. However, UCB with differentiation present with higher pathologic stage, thus explaining the aggressive clinical course in these patients.
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Affiliation(s)
- Anirban P Mitra
- Department of Pathology and Center for Personalized Medicine, University of Southern California Keck School of Medicine and Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Claudia C Bartsch
- Department of Urology, Johann Wolfgang Goethe University Hospital and Faculty of Medicine, Frankfurt, Germany
| | - Georg Bartsch
- Department of Urology, Johann Wolfgang Goethe University Hospital and Faculty of Medicine, Frankfurt, Germany
| | - Gus Miranda
- Institute of Urology, University of Southern California Keck School of Medicine and Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Eila C Skinner
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Siamak Daneshmand
- Institute of Urology, University of Southern California Keck School of Medicine and Norris Comprehensive Cancer Center, Los Angeles, CA.
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Mazzucchelli R, Scarpelli M, Lopez-Beltran A, Cheng L, Di Primio R, Montironi R. A contemporary update on pathology reporting for urinary bladder cancer. Int J Immunopathol Pharmacol 2012; 25:565-71. [PMID: 23058006 DOI: 10.1177/039463201202500302] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Providing the best management for patients with bladder cancer relies on close cooperation among uro-oncologists and pathologists. The pathologist is involved in the diagnosis and assessment of prognostic and therapeutic factors in bladder biopsies, transurethral resection (TUR) and cystectomy specimens. The pathologist must report accurately the key features using terms that are well understood by clinicians. Adequate clinical information is important to pathologists in deciding the best approach in handling and processing the surgical specimens.
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Affiliation(s)
- R Mazzucchelli
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
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Kim SP, Frank I, Cheville JC, Thompson RH, Weight CJ, Thapa P, Boorjian SA. The Impact of Squamous and Glandular Differentiation on Survival After Radical Cystectomy for Urothelial Carcinoma. J Urol 2012; 188:405-9. [DOI: 10.1016/j.juro.2012.04.020] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Indexed: 11/16/2022]
Affiliation(s)
- Simon P. Kim
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Prabin Thapa
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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Shah RB, Montgomery JS, Montie JE, Kunju LP. Variant (divergent) histologic differentiation in urothelial carcinoma is under-recognized in community practice: impact of mandatory central pathology review at a large referral hospital. Urol Oncol 2012; 31:1650-5. [PMID: 22608543 DOI: 10.1016/j.urolonc.2012.04.009] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 03/10/2012] [Accepted: 04/12/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE Urothelial carcinoma (UC) demonstrating variant histologic differentiation is associated with poor outcomes, and certain variants exhibit differing therapeutic responses compared with pure conventional UC. Little is known about the awareness and reporting practices of UC with variant histology in community practice. MATERIALS AND METHODS Patients diagnosed with UC based on an outside pathologic review had their pathology centrally reviewed before instituting therapy. A discordant diagnosis was defined as the presence of variant histologic differentiation not reported by the referring institution. Variant histologic differentiation was quantitated as focal (10%-50%) or extensive (>50%). RESULTS Of 589 transurethral biopsies (TURBTs), 115 (19.5%) UCs demonstrated variant histologic differentiation. Muscle invasion at TURBT and extravesical disease at cystectomy was present in 69% and 52%, respectively. Of 56 patients with at least 1 year follow-up, recurrence-free survival was 56%. The majority (90%) showed a single variant histology, which was extensive in 58% of cases. Squamous differentiation (32%) was the most common variant histology identified, followed by small cell (16%), glandular (13%), micropapillary (12%), nested (8%), sarcomatoid (6%), lymphoepithelial (3%), and plasmacytoid (1%) type. Variant histologic differentiation was not documented by the referring institution in 44% of cases, of which 47% were extensive. Commonly under-recognized patterns included lymphoepithelial (2) and plasmacytoid (1) types (100%), nested (7, 87%), micropapillary (10, 83%), and small cell (7, 44%). CONCLUSIONS This study emphasizes the importance of central pathology review in the management of bladder cancer patients and the need for increased awareness of this relatively common phenomenon in UC.
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Affiliation(s)
- Rajal B Shah
- Division of Urologic Pathology, Miraca Life Sciences Research Institute, Irving, TX 75039, USA.
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Jozwicki W, Windorbska W, Brozyna AA, Jochymski C, Basta P, Sikora J, Stasienko E, Dutsch-Wicherek M, Koper K, Wicherek L. The analysis of receptor-binding cancer antigen expressed on SiSo cells (RCAS1) immunoreactivity within the microenvironment of the ovarian cancer lesion relative to the applied therapeutic strategy. Cell Tissue Res 2011; 345:405-14. [PMID: 21845402 PMCID: PMC3168756 DOI: 10.1007/s00441-011-1216-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Accepted: 07/15/2011] [Indexed: 12/31/2022]
Abstract
RCAS1 is involved in generating the suppressive profile of the tumor microenvironment that helps cancer cells evade immune surveillance. The status of the cells surrounding the cancer nest may affect both the progression of the cancer and the development of metastases. In cases of ovarian cancer, a large number of patients do not respond to the applied therapy. The patient’s response to the applied therapy is directly linked to the status of the tumor microenvironment and the intensity of its suppressive profile. We analyzed the immunoreactivity of RCAS1 on the cells present in the ovarian cancer microenvironment in patients with the disease; these cells included macrophages and carcinoma-associated fibroblasts. Later we analyzed the immunoreactivity levels within these cells, taking into consideration the clinical stage of the cancer and the therapeutic strategy applied, such as the number of chemotherapy regiments, primary cytoreductive surgery, or the presence of advanced ascites. In the patients who did not respond to the therapy we observed significantly higher immunoreactivity levels of RCAS1 within the cancer nest than in those patients who did respond; moreover, in the non-responsive patients we found RCAS1 within both macrophages and carcinoma-associated fibroblasts. RCAS1 staining may provide information about the intensity of the immuno-suppressive microenvironment profile found in cases of ovarian cancer and its intensity may directly relate to the clinical outcome of the disease.
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Affiliation(s)
- Wojciech Jozwicki
- Department of Tumor Pathology and Pathomorphology of the Franciszek Lukaszczyk Oncology Center, the Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
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Chalasani V, Chin JL, Izawa JI. Histologic variants of urothelial bladder cancer and nonurothelial histology in bladder cancer. Can Urol Assoc J 2011; 3:S193-8. [PMID: 20019984 DOI: 10.5489/cuaj.1195] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Bladder cancer can be classified histologically as urothelial or non-urothelial. Urothelial cancer has a propensity for divergent differentiation, which has increasingly been recognized in recent years due to heightened awareness and improved immunohistochemistry techniques. Furthermore, the recent World Health Organization classification of urothelial cancers improved clarity on this issue, with its listing of 13 histologic variants of urothelial cancer. The divergent differentiation patterns include, amongst others, squamous, glandular, micropapillary, nested, lymphepithelioma-like, plasmacytoid and sarcomatoid variants of urothelial cancer. Attempts to quantify the amount of divergent differentiation present, such as using the nonconventional differentiation number, have been made recently, which will improve the ability to compare publications from different centres. Genetic-based studies have indicated that the histologic variants of urothelial cancer arise from a common clonal precursor. Mostly, the current evidence suggests that urothelial cancer with divergent differentiation has a worse prognosis when compared with pure urothelial cancer. This article will review the current literature on variant histologies of urothelial cancer, and well as new developments in pure squamous cell carcinoma, small cell carcinoma and adenocarcinoma of the bladder.
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Affiliation(s)
- Venu Chalasani
- Departments of Surgery & Oncology, Divisions of Urology & Surgical Oncology, London Health Sciences Centre-Victoria Hospital, London, ON
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Edgerton N, Sirintrapun SJ, Munoz M, Chen Z, Osunkoya AO. Micropapillary urothelial carcinoma of the urinary bladder: A clinicopathological analysis of 24 cases. Int J Urol 2010; 18:49-54. [DOI: 10.1111/j.1442-2042.2010.02672.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Interobserver Reproducibility in the Diagnosis of Invasive Micropapillary Carcinoma of the Urinary Tract Among Urologic Pathologists. Am J Surg Pathol 2010; 34:1367-76. [DOI: 10.1097/pas.0b013e3181ec86b3] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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37
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Lee JH, You HW, Lee CH. Spontaneous Intraperitoneal Bladder Perforation Associated with Urothelial Carcinoma with Divergent Histologic Differentiation, Diagnosed by CT Cystography. Korean J Urol 2010; 51:287-90. [PMID: 20428434 PMCID: PMC2858848 DOI: 10.4111/kju.2010.51.4.287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 02/26/2010] [Indexed: 11/19/2022] Open
Abstract
Spontaneous bladder perforation is a very rare event. Prompt diagnosis of this injury is very important, particularly with intraperitoneal perforation, because mortality increases if surgical repair is delayed. Previous studies have reported that plain cystography is the primary modality of imaging study rather than relatively insensitive computed tomography (CT) when bladder perforation is suspected. We report here a rare case of spontaneous intraperitoneal perforation of the bladder associated with urothelial carcinoma with divergent histologic differentiation, as diagnosed with CT cystography.
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Affiliation(s)
- Jee Han Lee
- Department of Urology, Kyung Hee University Graduate School of Medicine, Seoul, Korea
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Sung MT, Zhang S, Lopez-Beltran A, Montironi R, Wang M, Davidson DD, Koch MO, Cain MP, Rink RC, Cheng L. Urothelial carcinoma following augmentation cystoplasty: an aggressive variant with distinct clinicopathological characteristics and molecular genetic alterations. Histopathology 2009; 55:161-73. [DOI: 10.1111/j.1365-2559.2009.03363.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Wasco MJ, Daignault S, Zhang Y, Kunju LP, Kinnaman M, Braun T, Lee CT, Shah RB. Urothelial Carcinoma with Divergent Histologic Differentiation (Mixed Histologic Features) Predicts the Presence of Locally Advanced Bladder Cancer When Detected at Transurethral Resection. Urology 2007; 70:69-74. [PMID: 17656211 DOI: 10.1016/j.urology.2007.03.033] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Revised: 02/01/2007] [Accepted: 03/08/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The histologic classification of bladder tumors remains an important predictor of treatment response and patient outcome, with pure nonurothelial tumors associated with poorer outcome compared with pure urothelial carcinoma (UC). Little, however, is known about the significance of UC with divergent (mixed) histologic features at transurethral resection of bladder tumor (TURBT). This study examined the incidence, pathologic spectrum, and clinical significance of this phenomenon. METHODS The histologic patterns of 448 consecutive TURBT and 295 subsequent cystectomy specimens from this subgroup were analyzed. The type of divergent tumor differentiation observed in the mixed histologic type cases was categorized and quantified. Pure non-UC cases were excluded. Various clinicopathologic parameters were compared between the mixed histologic type and pure UC cohorts. RESULTS UC with mixed histologic features was identified in 25% of all TURBT specimens and was uniformly (100%) high grade and invasive (99%). The most common mixed histologic components were squamous (40%) and glandular (18%). Eleven percent of cases had multiple mixed histologic types. Compared with the pure high-grade UC, UCs with mixed histologic features were associated with muscle invasion at TURBT (chi-square test, P <0.001) and with extravesical disease at cystectomy (chi-square test, P = 0.0001). The presence of mixed histologic features at TURBT was an independent predictor of extravesical disease in a multivariate logistic model (P = 0.007). However, it was not significant for disease-specific survival in the univariate (P = 0.17) or multivariate (P = 0.68) models. CONCLUSIONS The results of our study have shown that the presence of mixed histologic features at TURBT indicates locally aggressive disease. Patients with mixed histologic features might benefit from an aggressive multimodality treatment strategy.
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Affiliation(s)
- Matthew J Wasco
- Department of Pathology, University of Michigan Medical Center, Ann Arbor, Michigan 48109, USA
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Gilligan T, Dreicer R. The atypical urothelial cancer patient: management of bladder cancers of non-transitional cell histology and cancers of the ureters and renal pelvis. Semin Oncol 2007; 34:145-53. [PMID: 17382798 DOI: 10.1053/j.seminoncol.2006.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Non-transitional cell neoplasms of the bladder and upper tract transitional cell carcinomas (ureter and renal pelvis) represent only a small fraction of urothelial carcinomas. Clinicians faced with the rare case are always confronted with management dilemmas complicated by the scarcity of published experience to guide decisions. The current review brings together the best of the limited published data in an attempt to provide some reasonable context to help in the management of these difficult neoplasms.
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Affiliation(s)
- Timothy Gilligan
- Department of Solid Tumor Oncology, Taussig Cancer Center, and Glickman Urologic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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Domanowska E, Jozwicki W, Domaniewski J, Golda R, Skok Z, Wiśniewska H, Sujkowska R, Wolski Z, Jozwicka G. Muscle-invasive urothelial cell carcinoma of the human bladder: multidirectional differentiation and ability to metastasize. Hum Pathol 2007; 38:741-6. [PMID: 17306328 DOI: 10.1016/j.humpath.2006.11.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2006] [Revised: 10/17/2006] [Accepted: 11/01/2006] [Indexed: 11/28/2022]
Abstract
Few published studies have addressed the correlation between multidirectional differentiation in muscle-invasive bladder cancer and its ability to metastasize. We demonstrated that histologic differentiation within a single tumor affects lymph node metastasis. We examined cystectomy specimens from 93 bladder tumors and 1085 lymph nodes. In this study, urothelial cell carcinomas (UCCs) with divergent differentiation, excluding pure divergent patterns such as squamous cell carcinoma and adenocarcinoma that tend toward a distinct biologic behavior, were subjected to histopathologic estimation. The positive lymph node ratio increased with the nonconventional differentiation number (NDN) within a tumor from 8.7% for an NDN of 0 (pure conventional UCCs) to 35.5% for an NDN of 2 or higher (mixed conventional and nonconventional [NC] UCCs showing >2 NC patterns). The positive lymph node number (PLN) was more than twice as high for an NDN of 3 or higher as compared with cases with an NDN of 0. Lymph node positivity (LP) was associated with the presence of micropapillary, lymphoma-like, plasmacytoid, giant cell, or clear cell-type tumors, and increasing PLN was associated with the presence of glandular, nested, lymphoma-like, plasmacytoid, or undifferentiated types in the primary tumor. By multivariate analysis, NDN status was determined to be an independent predictor of PLN (P = .032). Tumor stage had impact on LP (P = .002); however, in cases with a PLN of 4 or higher, the NDN became the only predictor of further dissemination (P = .016). No significant tumor grade impact on LP or PLN was found. Our results indicate that NC differentiation in the primary tumor is a good predictor of lymph node dissemination.
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Affiliation(s)
- Ewa Domanowska
- Department of Clinical Pathology, The Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
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