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

被引：48

作者：

Claps, Francesco ^{[1
,4
]}

van de Kamp, Maaike W. ^{[1
]}

Mayr, Roman

Bostrom, Peter J. ^{[13
,14
]}

Shariat, Shahrokh F. ^{[15
,16
,17
,18
]}

Hippe, Katrin ^{[8
]}

Bertz, Simone ^{[9
]}

Neuzillet, Yann ^{[1
,2
,19
]}

Sanders, Joyce ^{[2
]}

Otto, Wolfgang ^{[7
]}

van Der Heijden, Michiel S. ^{[3
]}

Jewett, Michael A. S. ^{[11
]}

Stoehr, Robert ^{[9
]}

Zlotta, Alexandre R. ^{[11
]}

Trombetta, Carlo ^{[4
]}

Eckstein, Markus ^{[9
]}

Mertens, Laura S. ^{[1
]}

Burger, Maximilian ^{[7
]}

Soorojebally, Yanish ^{[19
]}

Wullich, Bernd ^{[10
]}

Bartoletti, Riccardo ^{[6
]}

Radvanyi, Francois ^{[19
]}

Pavan, Nicola ^{[4
]}

Sirab, Nanour

Mir, M. Carmen

Pouessel, Damien ^{[19
,20
]}

van Der Kwast, Theo H. ^{[12
]}

Hartmann, Arndt ^{[9
]}

Lotan, Yair ^{[15
]}

Bussani, Rossana ^{[5
]}

Allory, Yves ^{[19
,21
]}

van Rhijn, Bas W. G. ^{[1
,7
,11
]}

机构：

[1] Antoni Leeuwenhoek Hosp, Netherlands Canc Inst, Dept Surg Oncol Urol, Amsterdam, Netherlands

[2] Antoni Leeuwenhoek Hosp, Netherlands Canc Inst, Core Facil Mol Pathol & Biobank, Amsterdam, Netherlands

[3] Antoni Leeuwenhoek Hosp, Netherlands Canc Inst, Dept Med Oncol, Amsterdam, Netherlands

[4] Univ Trieste, Dept Med Surg & Hlth Sci, Urol Clin, Trieste, Italy

[5] Univ Trieste, Dept Pathol, Trieste, Italy

[6] Univ Pisa, Dept Translat Res & New Technol, Unit Urol, Pisa, Italy

[7] Univ Regensburg, Caritas St Josef Med Ctr, Dept Urol, Regensburg, Germany

[8] Univ Med Ctr Regensburg, Dept Pathol, Regensburg, Germany

[9] Friedrich Alexander Univ Erlangen Nurnberg, Univ Hosp Erlangen, Inst Pathol, Erlangen, Germany

[10] Fdn Inst Valenciano Oncol, Dept Urol, Dept Urol & Pediat Urol, Erlangen, Germany

[11] Univ Toronto, Univ Hlth Network, Princess Margaret Canc Ctr, Dept Surg Urol & Surg Oncol, Toronto, ON, Canada

[12] Univ Toronto, Univ Hlth Network, Princess Margaret Canc Ctr, Dept Pathol, Toronto, ON, Canada

[13] Turku Univ Hosp, Dept Urol, Turku, Finland

[14] Univ Turku, Turku, Finland

[15] Univ Texas Southwestern Med Ctr, Dept Urol, Dallas, TX USA

[16] Weill Cornell Med Coll, Dept Urol, New York, NY USA

[17] Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, Vienna, Austria

[18] Charles Univ Prague, Fac Med 2, Dept Urol, Prague, Czech Republic

[19] PSL Res Univ, Inst Curie, Mol Oncol Team, CNRS,UMR 144, Paris, France

[20] Toulouse Univ Canc Ctr IUCT Oncopole, Claudius Regaud Inst, Dept Med Oncol, Toulouse, France

[21] Inst Curie, Dept Pathol, Paris, France

来源：

BJU INTERNATIONAL | 2023年 / 132卷 / 02期

关键词：

bladder urothelial carcinoma; radical cystectomy; variant histology; survival; prognosis; #BladderCancer; #blcsm; #utuc; #uroonc; OUTCOMES; CARCINOMA; METAANALYSIS;

D O I：

10.1111/bju.15984

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

ObjectivesTo evaluate variant histologies (VHs) for disease-specific survival (DSS) in patients with invasive urothelial bladder cancer (BCa) undergoing radical cystectomy (RC). Materials and MethodsWe 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). ResultsOverall, 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. ConclusionsMore 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.

引用

页码：170 / 180

页数：11

共 33 条

[1] Bladder Cancer: A Comparison Between Non-urothelial Variant Histology and Urothelial Carcinoma Across All Stages and Treatment Modalities [J].