TY - JOUR
T1 - Prognostic impact of variant histologies in urothelial bladder cancer treated with radical cystectomy
AU - Claps, Francesco
AU - van de Kamp, Maaike W.
AU - Mayr, Roman
AU - Bostrom, Peter J.
AU - Shariat, Shahrokh F.
AU - Hippe, Katrin
AU - Bertz, Simone
AU - Neuzillet, Yann
AU - Sanders, Joyce
AU - Otto, Wolfgang
AU - van der Heijden, Michiel S.
AU - Jewett, Michael A. S.
AU - Stöhr, Robert
AU - Zlotta, Alexandre R.
AU - Trombetta, Carlo
AU - Eckstein, Markus
AU - Mertens, Laura S.
AU - Burger, Maximilian
AU - Soorojebally, Yanish
AU - Wullich, Bernd
AU - Bartoletti, Riccardo
AU - Radvanyi, François
AU - Pavan, Nicola
AU - Sirab, Nanour
AU - Mir, M. Carmen
AU - Pouessel, Damien
AU - van der Kwast, Theo H.
AU - Hartmann, Arndt
AU - Lotan, Yair
AU - Bussani, Rossana
AU - Allory, Yves
AU - van Rhijn, Bas W. G.
N1 - Funding Information: The authors wish to acknowledge all patients who contributed their tissue for research. The authors also acknowledge the International Bladder Cancer Network and the Bladder Cancer Advocacy Network for providing the platform for us to collaborate on this project. We thank the Core Facility for Molecular Pathology & Biobanking of the Netherlands Cancer Institute – Antoni van Leeuwenhoek and the Tissue bank Unit–PRB Mondor for their assistance. Appropriate ethical approval was obtained at each site according to national regulations and the principles of the Declaration of Helsinki. Yann Neuzillet and Francesco Claps are supported by the EUSP Scholarship–European Association of Urology. Funding Information: The authors wish to acknowledge all patients who contributed their tissue for research. The authors also acknowledge the International Bladder Cancer Network and the Bladder Cancer Advocacy Network for providing the platform for us to collaborate on this project. We thank the Core Facility for Molecular Pathology & Biobanking of the Netherlands Cancer Institute – Antoni van Leeuwenhoek and the Tissue bank Unit–PRB Mondor for their assistance. Appropriate ethical approval was obtained at each site according to national regulations and the principles of the Declaration of Helsinki. Yann Neuzillet and Francesco Claps are supported by the EUSP Scholarship–European Association of Urology. Publisher Copyright: © 2023 BJU International.
PY - 2023/8
Y1 - 2023/8
N2 - 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.
AB - 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.
KW - #BladderCancer
KW - #blcsm
KW - #uroonc
KW - #utuc
KW - bladder urothelial carcinoma
KW - prognosis
KW - radical cystectomy
KW - survival
KW - variant histology
UR - http://www.scopus.com/inward/record.url?scp=85148512735&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/bju.15984
DO - https://doi.org/10.1111/bju.15984
M3 - Article
C2 - 36748180
SN - 1464-4096
VL - 132
SP - 170
EP - 180
JO - BJU international
JF - BJU international
IS - 2
ER -