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

Autor: Claps F; Department of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.; Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy., van de Kamp MW; Department of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Mayr R; Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany., Bostrom PJ; Department of Surgery (Urology) and Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada.; Department of Urology, Turku University Hospital and University of Turku, Turku, Finland., Shariat SF; Department of Urology, University of Texas Southwestern Medical center, Dallas, TX, USA.; Department of Urology, Weill Cornell Medical College, New York, NY, USA.; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic., Hippe K; Department of Pathology, University Medical Center - Regensburg, Regensburg, Germany., Bertz S; Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nurnberg, Erlangen, Germany., Neuzillet Y; Department of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.; Core Facility Molecular Pathology & Biobank, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.; Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, Paris, France., Sanders J; Core Facility Molecular Pathology & Biobank, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Otto W; Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany., van der Heijden MS; Department of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Jewett MAS; Department of Surgery (Urology) and Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada., Stöhr R; Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nurnberg, Erlangen, Germany., Zlotta AR; Department of Surgery (Urology) and Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada., Trombetta C; Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy., Eckstein M; Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nurnberg, Erlangen, Germany., Mertens LS; Department of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Burger M; Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany., Soorojebally Y; Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, Paris, France., Wullich B; Department of Urology & Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nurnberg, Erlangen, Germany., Bartoletti R; Unit of Urology, Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy., Radvanyi F; Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, Paris, France., Pavan N; Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy., Sirab N; Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, Paris, France., Mir MC; Department of Urology, Fundacion Instituto Valenciano Oncologia, Valencia, Spain., Pouessel D; Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, Paris, France.; Department of Medical Oncology, Claudius Regaud Institute, Toulouse University Cancer Center (IUCT) Oncopole, Toulouse, France., van der Kwast TH; Department of Pathology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada., Hartmann A; Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nurnberg, Erlangen, Germany., Lotan Y; Department of Urology, University of Texas Southwestern Medical center, Dallas, TX, USA., Bussani R; Department of Pathology, University of Trieste, Trieste, Italy., Allory Y; Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, Paris, France.; Department of Pathology, Institut Curie, Paris, France., van Rhijn BWG; Department of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.; Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany.; Department of Surgery (Urology) and Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada.
Jazyk: angličtina
Zdroj: BJU international [BJU Int] 2023 Aug; Vol. 132 (2), pp. 170-180. Date of Electronic Publication: 2023 Feb 20.
DOI: 10.1111/bju.15984
Abstrakt: Objectives: To evaluate variant histologies (VHs) for disease-specific survival (DSS) in patients with invasive urothelial bladder cancer (BCa) undergoing radical cystectomy (RC).
Materials and Methods: We analysed a multi-institutional cohort of 1082 patients treated with upfront RC for cT1-4aN0M0 urothelial BCa at eight centres. Univariable and multivariable Cox' regression analyses were used to assess the effect of different VHs on DSS in overall cohort and three stage-based analyses. The stages were defined as 'organ-confined' (≤pT2N0), 'locally advanced' (pT3-4N0) and 'node-positive' (pTanyN1-3).
Results: Overall, 784 patients (72.5%) had pure urothelial carcinoma (UC), while the remaining 298 (27.5%) harboured a VH. Squamous differentiation was the most common VH, observed in 166 patients (15.3%), followed by micropapillary (40 patients [3.7%]), sarcomatoid (29 patients [2.7%]), glandular (18 patients [1.7%]), lymphoepithelioma-like (14 patients [1.3%]), small-cell (13 patients [1.2%]), clear-cell (eight patients [0.7%]), nested (seven patients [0.6%]) and plasmacytoid VH (three patients [0.3%]). The median follow-up was 2.3 years. Overall, 534 (49.4%) disease-related deaths occurred. In uni- and multivariable analyses, plasmacytoid and small-cell VHs were associated with worse DSS in the overall cohort (both P = 0.04). In univariable analyses, sarcomatoid VH was significantly associated with worse DSS, while lymphoepithelioma-like VH had favourable DSS compared to pure UC. Clear-cell (P = 0.015) and small-cell (P = 0.011) VH were associated with worse DSS in the organ-confined and node-positive cohorts, respectively.
Conclusions: More than 25% of patients harboured a VH at time of RC. Compared to pure UC, clear-cell, plasmacytoid, small-cell and sarcomatoid VHs were associated with worse DSS, while lymphoepithelioma-like VH was characterized by a DSS benefit. Accurate pathological diagnosis of VHs may ensure tailored counselling to identify patients who require more intensive management.
(© 2023 BJU International.)
Databáze: MEDLINE
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