VARIANT HISTOLOGIC DIFFERENTIATION IN BLADDER CANCER TREATED WITH RADICAL CYSTECTOMY: INCIDENCE AND LONG TERM SURVIVAL IN A SINGLE INSTITUTION STUDY.

Risultato della ricerca: Other

Abstract

INTRODUCTION AND OBJECTIVES: Bladder cancer (BCa),may present with variant morphologic features that deviate from theurothelial common aspect. These characteristics that can be defined aspure or mixed variants may have prognostic and therapeuticimplications.METHODS: We retrospectively evaluated histopathologicaldata from 1,067 BCa patients treated with radical cystectomy (RC)and PLND for BCa between 1990 and 2013 at a single tertiary carereferral center. All specimen were evaluated by dedicated uropathologists.Uni- and multivariate Cox regression analyses tested theimpact of different histopathological variant CSM (cancer specificmortality) and OM (overall mortality) after accounting for age at surgery,pathological N stage, use of perioperative chemotherapy, numberof positive nodes, number of removed nodes, positive surgicalmargin, pathological T stage, lymph vascular invasion, use of adjuvantchemotherapy.RESULTS: Of 1,067 patients, 756 (70.9%) harbored pureurothelial BCa while 311 (29.1%) were found to have a variant. Ofthese, 202 (64.9%) had a mixed variant and 109 (35.1%) a purevariant. Considering uncommon variants, 21 (6.8%) were sarcomatoid,10 (3.2%) lymphoepitelial, 19 (6.1%) small cell, 4 (1.3%) plasmacitoid,2 (0.6%) nested, 109 (35.0%) squamous, 89 (28.6%) micropapillary,23 (7.4%) glandular and 34 (10.9%) multiple mixed. With a medianfollow up of 65 months, CSM and OM were recorded in 365 (34.2%),451 (42.3%) patients, respectively. The OM was 47% vs. 53% vs.59% for pure urothelial vs. mixed vs. pure variants, respectively (Logrank p¼0.011). The 5-years CSM was 44% vs. 47% vs. 53% for pureurothelial vs. mixed vs. pure variants, respectively (Log rank p¼0.019).At MVA Cox regression analyses, the presence of pure histologicalvariant was associated with higher CSM (HR: 1.60, p<0.005) and OM(HR: 1.55, p<0.004) as compared to pure urothelial cancer. However,no differences were recorded when mixed variants vs. pure transitionalwere analyzed (all p>0.3). In details, neuroendocrine (HR 4.30,CI 2.02-9.13, p<0.001), micropapillary (HR: 4.35, p¼0.02) and multiplemixed (HR: 1.73; p<0.03) variants were associated with higher CSMafter RC.CONCLUSIONS: Our study confirm the negative impact ofhistological variant on the prediction on both CSM and OM after RC.The presence of a pure histopathological variant represents a strongnegative predictor of survival, while patients with mixed urothelial andvariant histologies did not harbor an increased risk of CSM and OM, ascompared to conventional urothelial cancer.
Lingua originaleEnglish
Pagine766-766
Numero di pagine1
Stato di pubblicazionePublished - 2016

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