Accuracy of Transurethral Resection of the Bladder in Detecting Variant Histology of Bladder Cancer Compared with Radical Cystectomy

AbstractPurposeTo compare the outcome among patients with invasive bladder cancer treated with cystectomy alone with outcome among those treated with combined-modality treatment in a randomised phase III trial.Patients and methodsPatients with histologically confirmed invasive non-metastatic bladder cancer T2-3, N0 and M0 were randomly assigned to two arms: Arm 1: of which all patients underwent radical cystectomy (RC) alone; and Arm 2, of which all patients were subjected to maximal transurethral resection of bladder tumour, followed 2 weeks later by combined chemoradiotherapy. The whole pelvis received 46 Gy in 23 fractions over 4·5 weeks. Chemotherapy was administered concomitantly with radiotherapy with: cisplatin 70 mg/m2 q. 3 weeks and Gemcitabine 300 mg/m2 D 1, 8 and 15 q. 3 weeks for two cycles. Patients who had complete response were shifted to phase II treatment: 20 Gy/10 fractions/2 weeks to the bladder. Patients with residual tumour underwent RC.ResultsOf the 80 patients assigned Arm 2, a visibly completed transurethral resection of the bladder tumour was possible in 48 patients (60%). Phase I of combined chemoradiotherapy (CCRT) was accomplished in 74 patients. Post-induction urologic evaluation revealed no evidence of disease in 62 patients (83·8%) and residual disease in 12 patients (16·2%). Phase II of CCRT was completed in 58 of the 62 patients. The median follow-up for all patients is 27 months (range: 4–49). The 3-year overall survival (OS) for the combined-modality group and for the surgery group were 61 and 63%, respectively (p = 0·425), whereas the disease-specific survival (DSS) for each group was 69 and 73%, respectively (p = 0·714). The 3-year OS with bladder preservation for Arm 2 patients was 50%.Multivariate analysis for the whole series showed that tumour stage and performance status (PS) were the only factors independently associated with DSS, although PS was the only factor independently associated with OS. In addition, residual disease after transurethral resection of the bladder tumour in Arm 2 patients was independently associated with both DSS and OS.Acute toxicity was moderate and most of the late toxicities were grade 2 with no grade 4 toxicity and no treatment-related deaths, none required cystectomy for bladder contraction.ConclusionThis study demonstrates that trimodality bladder-preserving approach represents a valid alternative for suitable patients. The OS and DSS rates of patients treated with trimodality bladder-preserving protocol are comparable to the results reported on patients treated with immediate radical cystectomy.

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Oncologic Surveillance for Variant Histology Bladder Cancer after Radical Cystectomy

The Journal of Urology ◽

10.1097/ju.0000000000001886 ◽

2021 ◽

Author(s):

Alberto Martini ◽

Luca Afferi ◽

Stefania Zamboni ◽

Julianne G. Schultz ◽

Chiara Lonati ◽

...

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Variant Histology

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BRCA1/RAP80/AEG1/REV3/TS Gene Expression in Tumor Samples from Bladder Cancer: Different Patient Profile between Transurethral Resection Versus Radical Cystectomy and Its Correlation in Bladder Cancer Prognosis

Molecular Biology ◽

10.4172/2168-9547.1000122 ◽

2015 ◽

Vol 04 (01) ◽

Author(s):

Ana Medina Guadalupe Aparicio

Keyword(s):

Gene Expression ◽

Bladder Cancer ◽

Radical Cystectomy ◽

Transurethral Resection ◽

Cancer Prognosis ◽

Patient Profile

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Adjuvant chemotherapy is ineffective in patients with bladder cancer and variant histology treated with radical cystectomy

European Urology Open Science ◽

10.1016/s2666-1683(20)33657-0 ◽

2020 ◽

Vol 19 ◽

pp. e1586-e1587

Author(s):

S. Zamboni ◽

P. Baumeister ◽

A. Aziz ◽

C. Poyet ◽

C. Simeone ◽

...

Keyword(s):

Bladder Cancer ◽

Adjuvant Chemotherapy ◽

Radical Cystectomy ◽

Variant Histology

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Impact of histologic subtype on bladder cancer outcome.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.6_suppl.391 ◽

2017 ◽

Vol 35 (6_suppl) ◽

pp. 391-391

Author(s):

Samuel L Washington ◽

Thomas Sanford ◽

Michael S. Leapman ◽

Maxwell V. Meng ◽

Sima P. Porten

Keyword(s):

Overall Survival ◽

Squamous Cell Carcinoma ◽

Bladder Cancer ◽

Cell Carcinoma ◽

Radical Cystectomy ◽

Small Cell Carcinoma ◽

Squamous Cell ◽

Small Cell ◽

Variant Histology ◽

The Impact

391 Background: Variant histology is increasingly recognized but its impact on outcomes is less well known compared to urothelial carcinoma (UC). We aim to evaluate the impact of variant histology on bladder cancer outcomes using the National Cancer Database (NCDB), a U.S. population-based cohort capturing approximately 70% of newly diagnosed cancer cases. Methods: We identified patients with bladder cancer from 2004 to 2013 treated with radical cystectomy. We compared clinical and pathologic characteristics between those with UC and those with variant histology. Chi-square test was utilized for categorical variables and Independent Samples t-test for continuous variables. Multivariable Cox regression was used with hazard ratios (HR) and 95% confidence intervals (CI) to identify independent predictors of overall survival. Results: A total of 40,918 patients were identified with mean age 67 years, with male (75%) and Caucasian (90.9%) predominance. Median follow-up was 36.9 months (IQR 16.1-67.5). Squamous cell carcinoma (4.4%), small cell carcinoma (1.6%) and micropapillary (0.9%) were the most common variant histologies. Variant histology was found more commonly in women (35.6% vs 23.4%, p < 0.05), black (8.8% vs 5.6%, p < 0.05), stage pT3 or T4 (67% vs 50.2%, p < 0.05) and node positive (30.8% vs 26.9%, p < 0.05). In adjusted models squamous cell carcinoma (HR 1.3, 95% CI 1.2-1.4), small cell carcinoma (HR 1.6, 95% CI 1.5-1.8) and black ethnicity (HR 1.2, 95% CI 1.1-1.2) were independent predictors of increased mortality risk while micropapillary was associated with decreased risk (HR 0.8, 95% CI 0.7-1.0) after controlling for age, gender, surgical margin status, pathologic T stage, pathologic N stage and history of chemotherapy. All associations remained statistically significant (p < 0.05). Conclusions: Non-urothelial histology was associated with worse overall survival in patients with bladder cancer treated with radical cystectomy; however, contrary to some previous reports, micropapillary variant was associated with lower risk of death. In addition, black ethnicity was associated with worse survival. Further investigation is needed to explore the impact of variant histology as well as other socioeconomic factors on survival after cystectomy.

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A Contemporary Update on Pathology Standards for Bladder Cancer: Transurethral Resection and Radical Cystectomy Specimens

European Urology ◽

10.1016/j.eururo.2012.10.008 ◽

2013 ◽

Vol 63 (2) ◽

pp. 321-332 ◽

Cited By ~ 58

Author(s):

Donna E. Hansel ◽

Mahul B. Amin ◽

Eva Comperat ◽

Richard J. Cote ◽

Ruth Knüchel ◽

...

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Transurethral Resection

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Incidence and effect of variant histology on oncological outcomes in patients with bladder cancer treated with radical cystectomy

Urologic Oncology Seminars and Original Investigations ◽

10.1016/j.urolonc.2016.12.006 ◽

2017 ◽

Vol 35 (6) ◽

pp. 335-341 ◽

Cited By ~ 32

Author(s):

Marco Moschini ◽

Paolo Dell’Oglio ◽

Roberta Luciano’ ◽

Giorgio Gandaglia ◽

Francesco Soria ◽

...

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Oncological Outcomes ◽

Variant Histology

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BLADDER CANCER AND DEBATE ON TRIMODAL THERAPY (TMT) FOR BLADDER PRESERVATION

Amadeus International Multidisciplinary Journal ◽

10.14295/aimj.v2i4.30 ◽

2018 ◽

Vol 2 (4) ◽

pp. 52-56

Author(s):

Antonio Marlos Duarte de Melo ◽

José Angelo Araújo Sampaio ◽

Ana Beatriz Callou Sampaio Neves ◽

Isabella Callou Sampaio Neves ◽

Lucas Leimig Telles Parente ◽

...

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Transurethral Resection ◽

Malignant Neoplasms ◽

Bladder Preservation ◽

Invasive Tumor ◽

Trimodal Therapy ◽

Keywords Bladder Cancer ◽

Short Time ◽

Lower Morbidity

Abstract: Bladder Cancer is one of the most common types of malignant neoplasms that affects both men and women. The surgery considered standard for the treatment of invasive tumor is Radical Cystectomy, which causes undesirable morbidity in the postoperative period on affected patients. Radical Transurethral Resection (TRU), associated with Chemotherapy and Radiotherapy, together form the Trimodal Therapy (TTM), which can demonstrate satisfactory results in the approach of the patient with invasive tumor with lower morbidity and well-timed survival rate, in a short time. Keywords: Bladder Cancer; Radical Cystectomy; Transurethral Resection; Trimodal Therapy.

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