MP21-20 THE IMPACT OF PLASMACYTOID VARIANT HISTOLOGY ON SURVIVAL OF PATIENTS WITH UROTHELIAL CARCINOMA OF BLADDER AFTER RADICAL CYSTECTOMY

278 Background: The role of variant histology bladder cancer as an independent prognostic factor for survival after radical cystectomy is poorly defined. Our aim was to examine the impact of variant histology on survival. Methods: A retrospective analysis of prospectively collected data from the University of Southern California Bladder Cancer Database was performed. Between 1971 and 2008, 2098 patients underwent radical cystectomy and extended pelvic lymph node dissection for primary bladder cancer. All surgical specimens underwent centralized pathologic review by dedicated genitourinary pathologists. Histologic type was categorized according to the WHO/ISUP 1998 classification as urothelial carcinoma (UC; n=1595), UC + variant (n=380), or non-urothelial carcinoma (Non-UC; n=123). The outcomes were overall survival (OS) and recurrence-free survival (RFS). The Kaplan-Meier method and Cox proportional regression models were used to analyze survival data. Results: The median follow-up duration was 12.8 years (range, 0 to 36.6 years). The predicted 5-year OS (61%, 53%, and 47%, Log rank p=0.005) and RFS (68%, 59%, and 58%, Log rank p=0.001) rates differed between patients with UC, UC + variant, and Non-UC histology. Multivariable analysis showed that Non-UC (but not UC + variant) histology was independently associated with OS (Non-UC versus UC: HR 1.26, 95% CI 1.01 to 1.57, p=0.040; UC + variant versus UC: HR 0.97, 95% CI 0.85 to 1.12, p=0.697) but not RFS (Non-UC versus UC: HR 1.14, 95% CI 0.83 to 1.56, p=0.411; UC + variant versus UC: HR 1.06, 95% CI 0.88 to 1.28, p=0.551). Conclusions: Non-UC histology was independently associated with poorer OS after radical cystectomy for bladder cancer. Clinical trials are needed to determine whether this high risk group will benefit from multimodal therapy.

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A propensity score matched analysis of the impact of variant histology of squamous cell carcinoma and surgical experience on survival after radical cystectomy

European Urology Open Science ◽

10.1016/s2666-1683(20)33615-6 ◽

2020 ◽

Vol 19 ◽

pp. e1530

Author(s):

S. Rodler ◽

L. Eismann ◽

P. Pfitzinger ◽

F. Jokisch ◽

C. Stief ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Propensity Score ◽

Cell Carcinoma ◽

Radical Cystectomy ◽

Squamous Cell ◽

Surgical Experience ◽

Variant Histology ◽

The Impact

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MP58-10 THE ASSOCIATION OF CIRCULATING TUMOR CELLS AND VARIANT HISTOLOGY ON OUTCOMES IN UROTHELIAL CARCINOMA OF THE BLADDER TREATED WITH RADICAL CYSTECTOMY

The Journal of Urology ◽

10.1016/j.juro.2015.02.2149 ◽

2015 ◽

Vol 193 (4S) ◽

Author(s):

Armin Soave ◽

Sabine Riethdorf ◽

Lars Weisbach ◽

Sarah Minner ◽

Oliver Engel ◽

...

Keyword(s):

Urothelial Carcinoma ◽

Tumor Cells ◽

Radical Cystectomy ◽

Circulating Tumor Cells ◽

Variant Histology ◽

Carcinoma Of The Bladder

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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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Outcomes of radical cystectomy for micropapillary urothelial carcinoma at the University of Southern California.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.5_suppl.300 ◽

2012 ◽

Vol 30 (5_suppl) ◽

pp. 300-300

Author(s):

Adrian Stuart Fairey ◽

Siamak Daneshmand ◽

Anne Schuckman ◽

Gary Leiskovsky ◽

Hooman Djaladat ◽

...

Keyword(s):

Bladder Cancer ◽

Urothelial Carcinoma ◽

Radical Cystectomy ◽

Survival Data ◽

Southern California ◽

Multivariable Analysis ◽

University Of Southern California ◽

Histologic Type ◽

The University ◽

The Impact

300 Background: The role of micropapillary urothelial carcinoma (MUC) variant histology as an independent prognostic factor for survival after radical cystectomy has not been studied. Our aim was to examine the impact of MUC on survival. Methods: A retrospective analysis of prospectively collected data from the University of Southern California (USC) Bladder Cancer Database was performed. Between 1985 and 2008, 1681 patients underwent radical cystectomy and extended pelvic lymph node dissection for primary bladder cancer. All surgical specimens underwent central pathologic review by dedicated genitourinary pathologists. Histologic type was categorized according to the WHO/ISUP 1998 classification as urothelial carcinoma (UC; n=1648) or MUC (n=33). The outcomes were overall survival (OS) and recurrence-free survival (RFS). The Kaplan-Meier method and Cox proportional regression models were used to analyze survival data. Results: The median follow-up duration was 10 years (range, 0 to 25 years). Baseline characteristics were similar between histologic types except MUC was associated with advanced clinical (cTanyN1-3: 2% versus 9%, p=0.03) and pathologic (pTanyN1-3: 23% versus 46%, p=0.01) TNM stage, multifocality (37% versus 58%, p=0.02), and high nuclear grade (84% versus 97%, p=0.04). The predicted 5-year OS (59% and 67%, Log rank p=0.79) and RFS (67% and 58%, Log rank p=0.50) rates did not differ between patients with UC and MUC. Multivariable analysis showed that histologic type was not independently associated with OS (HR 0.92, 95% CI 0.56 to 1.50, p=0.73) or RFS (HR 0.92, 95% CI 0.52 to 1.63, p=0.77). Conclusions: Outcomes of radical cystectomy for patients with MUC are similar to those with UC when controlling for other clinical and pathologic factors.

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