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Guo CC, Lee S, Lee JG, Chen H, Zaleski M, Choi W, McConkey DJ, Wei P, Czerniak B. Molecular profile of bladder cancer progression to clinically aggressive subtypes. Nat Rev Urol 2024; 21:391-405. [PMID: 38321289 DOI: 10.1038/s41585-023-00847-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 02/08/2024]
Abstract
Bladder cancer is a histologically and clinically heterogenous disease. Most bladder cancers are urothelial carcinomas, which frequently develop distinct histological subtypes. Several urothelial carcinoma histological subtypes, such as micropapillary, plasmacytoid, small-cell carcinoma and sarcomatoid, show highly aggressive behaviour and pose unique challenges in diagnosis and treatment. Comprehensive genomic characterizations of the urothelial carcinoma subtypes have revealed that they probably arise from a precursor subset of conventional urothelial carcinomas that belong to different molecular subtypes - micropapillary and plasmacytoid subtypes develop along the luminal pathway, whereas small-cell and sarcomatoid subtypes evolve along the basal pathway. The subtypes exhibit distinct genomic alterations, but in most cases their biological properties seem to be primarily determined by specific gene expression profiles, including epithelial-mesenchymal transition, urothelial-to-neural lineage plasticity, and immune infiltration with distinct upregulation of immune regulatory genes. These breakthrough studies have transformed our view of bladder cancer histological subtype biology, generated new hypotheses for therapy and chemoresistance, and facilitated the discovery of new therapeutic targets.
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Affiliation(s)
- Charles C Guo
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sangkyou Lee
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - June G Lee
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Huiqin Chen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Zaleski
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Woonyoung Choi
- Johns Hopkins Greenberg Bladder Cancer Institute, Johns Hopkins University, Baltimore, MD, USA
| | - David J McConkey
- Johns Hopkins Greenberg Bladder Cancer Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Peng Wei
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bogdan Czerniak
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Park HK. Do Histology and Primary Tumor Location Influence Metastatic Patterns in Bladder Cancer? Curr Oncol 2023; 30:9078-9089. [PMID: 37887556 PMCID: PMC10605465 DOI: 10.3390/curroncol30100656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 09/30/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023] Open
Abstract
Metastasis is the leading cause of death in patients with bladder cancer. This study utilized a statistical analysis of patient data from the Surveillance, Epidemiology, and End Results database to examine the influence of histological type and primary site on the metastatic behavior of bladder cancer. Significantly different metastatic patterns were observed among bladder cancer patients depending on their histological type. Patients with squamous cell carcinoma showed a significantly (p < 0.001) lower bone metastasis rate (27.2%) than patients with urothelial carcinoma (UC) (38.3%). Patients with neuroendocrine carcinoma showed a significantly (p < 0.001) higher liver metastasis rate (52.1%) and a significantly (p = 0.001) lower lung metastasis rate (25.7%) than patients with UC (22.6% and 33.5%, respectively). UC patients also demonstrated differences in metastatic behavior according to histological subtype. The sarcomatoid subtype showed a significantly (p < 0.001) higher lung metastasis rate (51.6%) and a significantly lower (p = 0.002) lymph node metastasis rate (22.6%) than the micropapillary subtype (12.1% and 54.1%, respectively). Significant differences in metastatic behavior were also observed among patients with conventional UCs originating from the bladder, ureter, and renal pelvis. This study highlights the impact of histological characteristics and primary site on metastatic tendencies in bladder cancer, highlighting the importance of tailoring treatment and surveillance strategies.
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Affiliation(s)
- Hyung Kyu Park
- Department of Pathology, Chungnam National University School of Medicine, Daejeon 35015, Republic of Korea
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