Overview of histologic variants of urothelial carcinoma: current trends and narrative review on treatment outcomes.

Autor:	Ogbue O; Department of Medicine, Cleveland Clinic/Fairview Hospital, Cleveland, OH, USA., Haddad A; Department of Hematology/Oncology, Cleveland Clinic Cancer Center, Cleveland, OH, USA., Almassi N; Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA., Lapinski J; Department of Pathology, Cleveland Clinic/Fairview Hospital, Cleveland, OH, USA., Daw H; Department of Hematology/Oncology, Cleveland Clinic Cancer Center, Cleveland, OH, USA.
Jazyk:	angličtina
Zdroj:	Translational andrology and urology [Transl Androl Urol] 2022 Jun; Vol. 11 (6), pp. 877-901.
DOI:	10.21037/tau-22-43
Abstrakt:	Background and Objective: The histologic variants of urothelial carcinoma (UC) are tumors arising from within the urothelium in which some component of the tumor morphology is other than urothelial. They are underdiagnosed, aggressive and have varying pathologic response rates to systemic chemotherapy. There are no consensus guidelines on the use of systemic chemotherapy in variant histology (VH) of UC. We performed a contemporary review on pathologic response rates to neoadjuvant systemic therapy and survival outcomes following radical cystectomy in order to provide a rationale for clinical practice recommendations on the management of UC with VH. Methods: A PubMed literature search was conducted for all English articles from inception reporting either pathological response rates to neoadjuvant treatment or survival outcomes after radical cystectomy in non-metastatic VH of UC. Key Content and Findings: Neoadjuvant chemotherapy (NAC) prior to radical cystectomy was shown to be a beneficial treatment strategy in UC with VH. The micropapillary, plasmacytoid, nested and sarcomatoid histologic variants were associated with worse survival outcomes compared to conventional UC and UC with squamous or glandular differentiation despite initial downstaging with chemotherapy. There is evidence of improved survival in patients with sarcomatoid differentiation receiving NAC compared to RC alone. The major prognostic factors that affect survival outcomes in VH of UC include histologic variant subtype, patient age, presence of lymphovascular invasion, hydronephrosis, nodal metastasis and advanced T stage at diagnosis. Recent studies demonstrate that VH of UC are heterogenous tumors and responsiveness to NAC may be a function of the molecular subtypes present. Conclusions: Based on these findings, NAC to achieve pathologic downstaging prior to radical cystectomy is recommended for MIBC with VH. Biomarkers identified by molecular profiling with immunohistochemistry will need to be validated as predictors of response to NAC in future trials. Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-22-43/coif). The authors have no conflicts of interest to declare. (2022 Translational Andrology and Urology. All rights reserved.)
Databáze:	MEDLINE
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