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Ramos P, Mateus A, Manso M, Botelho F, Silva A, Silva J, Silva C, Pacheco-Figueiredo L. Prognostic impact of variant histology in bladder cancer: Would early and aggressive treatment shift the paradigm? Urol Oncol 2024; 42:161.e1-161.e8. [PMID: 38267300 DOI: 10.1016/j.urolonc.2024.01.009] [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: 10/15/2023] [Revised: 12/22/2023] [Accepted: 01/07/2024] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Bladder cancer (BC) is an increasingly frequent malignancy worldwide. Several variant histologies (VH) have been described in BC with a distinct clinical behavior. OBJECTIVES This study aims to assess the prognostic impact of VH in BC, comparing its outcomes to pure urothelial carcinoma PUC in both non-muscle invasive (NMIBC) and muscle-invasive (MIBC) settings. METHODS We included patients with primary BC, comparing those with VH with those with PUC, with an age and sex-matched proportion of 1:3, considering stage at diagnosis, recurrence-free, progression-free, and overall survival (OS). A total of 616 patients were included in the study, (460 UC and 151 VH). RESULTS After first TURBT, MIBC was present in 99 (64.1%) of patients with VH, and 95 (20.6%) with UC (p<0.001). Concerning NMIBC, we observed higher rates of progression to MIBC amid patients with VH (p=0.009). Nodal involvement (p=0.020) and metastatic disease (p<0.001) were significantly higher within the VH group. A higher OS was observed among patients with NMIBC of PUC (p<0.001). There were no statistically significant differences of metastasis-free survival and OS between VH and UC groups within the MIBC setting. CONCLUSION We confirmed that VH presents a more aggressive clinical course compared to PUC. An earlier radical treatment within the NMIBC setting could increase the oncological outcomes of the VH patients.
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Affiliation(s)
- Pedros Ramos
- School of Medicine, University of Minho, Braga, Portugal; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; Department of Urology, Centro Hosspitalar São João, Porto, Portugal.
| | - André Mateus
- School of Medicine, University of Minho, Braga, Portugal
| | - Margarida Manso
- Department of Urology, Centro Hosspitalar São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Francisco Botelho
- School of Medicine, University of Minho, Braga, Portugal; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; Department of Urology, Centro Hosspitalar São João, Porto, Portugal
| | - André Silva
- Faculty of Medicine, University of Porto, Porto, Portugal; Department of Urology, Trofa Saúde Private Hospitals, Portugal
| | - João Silva
- Department of Urology, Centro Hosspitalar São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Carlos Silva
- Department of Urology, Centro Hosspitalar São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Luis Pacheco-Figueiredo
- School of Medicine, University of Minho, Braga, Portugal; Department of Urology, Trofa Saúde Private Hospitals, Portugal
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Efiloğlu Ö, Çakıcı MÇ, Kır G, İplikçi A, Turan T, Cecikoğlu GE, Yıldırım A. The Impact of Histological Variants on Oncological Outcomes in Patients with Muscle Invasive Bladder Cancer Treated with Radical Cystectomy. UROLOGY RESEARCH & PRACTICE 2023; 49:246-252. [PMID: 37877826 PMCID: PMC10541520 DOI: 10.5152/tud.2023.22223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 04/11/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVE Bladder cancer is a heterogeneous entity characterized by a wide range of different morphologies. The aim of this study was to investigate the prognostic effect of bladder tumor with variant histology that is treated with radical cystectomy on oncological outcomes. METHODS One hundred eighty-six patients who underwent radical cystectomy between September 2001 and June 2020 were included in the study. The patients were divided into 2 groups variant histology group (n = 54) and transitional cell cancer group (n = 132). Clinicopathologic data were compared between the two groups. RESULTS The groups were similar in terms of demographic characteristics. In the mul- tivariate analysis of cancer-specific survival in transitional cell cancer against variant histology, high-grade detection of primary transurethral bladder tumor pathology, cystectomy pT, cystectomy positive lymph node, and positive surgical margin in cys- tectomy were determined to be statistically significant. Diagnosis of pT2 and high grade of primary transurethral bladder tumor pathology, cystectomy ≥ pT3, cystec- tomy positive lymph node, and positive surgical margin in cystectomy were statis- tically significant in multivariate analysis of overall survival. Cancer-specific survival time was estimated at 65.1 ± 8.3 months for variant histology and 134.2 ± 10.4 months for transitional cell cancer (P=.004). The estimated overall survival time was 61.9 ± 8.0 months in variant histology and 119.0 ± 9.8 months in transitional cell cancer (P = .014). CONCLUSION Pathological features and prognosis of bladder cancer with variant histol- ogies are worse than those of pure urothelial bladder cancer. Overall survival and can- cer-specific survival are shorter in bladder cancer with variant histology than in pure urothelial bladder cancer. Following the diagnosis of variant histology in transurethral bladder tumor, poor prognosis must be considered in the treatment plan.
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Affiliation(s)
- Özgür Efiloğlu
- Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey
| | | | - Gözde Kır
- Department of Pathology, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ayberk İplikçi
- Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey
| | - Turgay Turan
- Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey
| | | | - Asıf Yıldırım
- Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey
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Komina S, Petrusevska G, Janevska V, Jovanovic R, Zdravkovski P, Saidi S, Zafirovska BI, Topuzovska S. Effect of bladder cancer variant histology on survival outcome in patients treated with radical cystectomy: A single-centre experience. Urol Ann 2021; 13:288-295. [PMID: 34421267 PMCID: PMC8343292 DOI: 10.4103/ua.ua_95_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/27/2020] [Indexed: 12/24/2022] Open
Abstract
Context Bladder cancer (BC) is the sixth most common malignant neoplasm in men. Recently, great effort has been devoted to the study of BC variant histology (VH). Yet, the results from these studies have shown conflicting data and remain unclear whether their presence alters recurrence and survival rates after radical cystectomy (RC). Aims We undertook this study aiming to test the effect on VH on recurrence-free survival (RFS) and overall survival (OS) in single-center RC patients. Settings and Design We have retrospectively analyzed medical records and pathology reports from 331 patients who underwent RC with or without pelvic lymphadenectomy at University Urology Clinic-Skopje, North Macedonia, in the period between 2010 and 2018. Subjects and Methods Microscopic analysis of the specimens involved the evaluation of histological tumor type, tumor grade, pathological tumor node metastasis stage, presence of lymphovascular invasion, and resection margin status. Statistical Analysis Used Univariable and multivariable Cox regression models were applied to test the effect of VH on RFS and OS. Results We found 185 patients who matched our inclusion criteria. At multivariable analyses, lymphovascular invasion and positive resection margins were associated with shorter RFS. Similarly, patients diagnosed with lymphovascular invasion, positive resection margins, and a pelvic lymph node metastasis had poorer OS. VH was not found to be an independent predictor of both RFS and OS (P > 0.05). Conclusions The present study did not reveal prognostic effect of VH on RFS and OS. In our series, histomorphologic parameters including lymphovascular invasion, resection margins, and pelvic lymph node metastasis were the most relevant predictors on survival outcome after RC.
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Affiliation(s)
- Selim Komina
- Faculty of Medicine, Institute of Pathology, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Gordana Petrusevska
- Faculty of Medicine, Institute of Pathology, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Vesna Janevska
- Faculty of Medicine, Institute of Pathology, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Rubens Jovanovic
- Faculty of Medicine, Institute of Pathology, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Pance Zdravkovski
- Faculty of Medicine, Institute of Pathology, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Skender Saidi
- Faculty of Medicine, University Clinic of Urology, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Beti Ivanovska Zafirovska
- Institute of Epidemiology and Biostatistics with Medical Informatics, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Sonja Topuzovska
- Faculty of Medicine, Institute of Medical and Experimental Biochemistry, Ss. Cyril and Methodius University, Skopje, North Macedonia
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Deuker M, Martin T, Stolzenbach F, Rosiello G, Collà Ruvolo C, Nocera L, Tian Z, Becker A, Kluth L, Roos FC, Tilki D, Shariat SF, Black PC, Kassouf W, Saad F, Chun F, Karakiewicz PI. Bladder Cancer: A Comparison Between Non-urothelial Variant Histology and Urothelial Carcinoma Across All Stages and Treatment Modalities. Clin Genitourin Cancer 2020; 19:60-68.e1. [PMID: 32782133 DOI: 10.1016/j.clgc.2020.07.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/13/2020] [Accepted: 07/12/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate stage at presentation, treatment rates, and cancer-specific mortality (CSM) of non-urothelial variant histology (VH) bladder cancer (BCa) relative to urothelial carcinoma of the urinary bladder (UCUB). MATERIALS AND METHODS Within the Surveillance, Epidemiology, and End Results registry (SEER, 2004-2016), patients with VH BCa and UCUB were identified. Stage at presentation and treatment rates, as well as multivariably adjusted and matched CSM rates according to TNM stage within each histologic subtype, were reported. RESULTS Of all 222,435 eligible patients with BCa, 11,147 (5.0%) harbored VH. Among those, squamous cell carcinoma accounted for 3666 (1.6%) patients, adenocarcinoma for 1862 (0.8%), neuroendocrine carcinoma for 1857 (0.8%), and other VH BCa for 3762 (1.7%) of the study cohort. Patients with VH BCa showed invariably more advanced TNM stage at presentation compared with patients with UCUB. Treatment rates according to TNM stages showed similar distribution of cystectomy rates in VH BCa and UCUB. However, important differences in the distribution of radiotherapy and chemotherapy rates existed within VH BCa and in comparison with UCUB. Furthermore, even after multivariable adjustment and matching with UCUB, squamous cell carcinoma exhibited higher CSM (hazard ratios, 1.43-1.95; all P < .01) across all stages. All other VH predominantly exhibited higher CSM than UCUB in either non-muscle-invasive or muscle-invasive nonmetastatic stages. CONCLUSION TNM stage at diagnosis is invariably more advanced in all patients with VH BCa versus patients with UCUB. Of all VH BCa, in multivariably adjusted stage for stage analyses, squamous cell carcinoma appears to have the worst natural history. All other VH subgroups exhibited more aggressive natural history than UCUB in nonmetastatic stages only.
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Affiliation(s)
- Marina Deuker
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
| | - Thomas Martin
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Franziska Stolzenbach
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Giuseppe Rosiello
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Claudia Collà Ruvolo
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, University of Naples Federico II, Naples, Italy
| | - Luigi Nocera
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Andreas Becker
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Luis Kluth
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Frederik C Roos
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Department of Urology, University of Jordan, Amman, Jordan
| | - Peter C Black
- Department of Urologic Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, British Colombia, Canada
| | - Wassim Kassouf
- Department of Urology, McGill University Health Centre, Montréal, Québec, Canada
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Felix Chun
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
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Mantica G, Simonato A, Du Plessis DE, Maffezzini M, De Rose AF, van der Merwe A, Terrone C. The pathologist's role in the detection of rare variants of bladder cancer and analysis of the impact on incidence and type detection. MINERVA UROL NEFROL 2018; 70:594-597. [PMID: 30203936 DOI: 10.23736/s0393-2249.18.03175-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Histology is one of the most important factors determining the prognosis of bladder cancers and rare variants are generally associated with decreased disease specific survival compared to pure transitional cell carcinomas. We believe that rare bladder cancer variants are likely underdiagnosed in the absence of a dedicated uro-pathologist in many centers. The objective of this study is to evaluate the contribution of a dedicated uro-pathologist on the identification of rare bladder cancer variants. METHODS We retrospectively analyzed the clinical and histological records of all patients which underwent a radical cystectomy and lymph node dissection between January 2000 and September 2015. The sample was divided in two groups: Group A, consists of patients who underwent radical cystectomy in the absence of a dedicated uro-pathologist at our institution, whereas the Group B consists of patients who underwent surgery when a dedicated uro-pathology service was available. We then evaluated the impact of a dedicated uro-pathologist on rare variants detection. RESULTS One hundred thirty-seven out of 551 (24.9%) of patients who underwent RC had at least one rare variant. In Group A 38/238 (16%) of patients showed a rare variant, while 99/313 (31.6%; P<0.001) in group B. Furthermore, the diagnosis of sarcomatoid variant was statistically significantly less common in group A (P=0.0026). The concordance between final radical cystectomy histology and previous transurethral resection of bladder tumor (TURBT) histology was poor in both groups (overall 50.4%). CONCLUSIONS The presence of a dedicated urological anatomical pathologist is of paramount importance and significantly increases the detection rate of non-transitional cell carcinoma bladder cancer types, but it does not increase the concordance rate between histological diagnoses in TURBT and radical cystectomy specimens.
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Affiliation(s)
- Guglielmo Mantica
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy - .,Department of Urology, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa -
| | | | - Danelo E Du Plessis
- Department of Urology, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
| | - Massimo Maffezzini
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| | - Aldo F De Rose
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| | - André van der Merwe
- Department of Urology, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
| | - Carlo Terrone
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
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