Impact of urothelial carcinoma with divergent differentiation on tumor stage

Background: Urinary bladder cancer is classified as urothelial or non-urothelial. Ninenty percent of bladder cancer are urothelial and has propensity for divergent differentiation. Squamous differentiation is associated with unfavourable prognostic features. The aim of this study is to determine the significance of urothelial carcinoma with divergent differentiation in relation to tumor stage and lymphovascular as well as perineural invasion in radical cystectomy and partial cystectomy specimen.Materials and methods: This prospective study was done among 51 patients who underwent radical cystectomy or partial cystectomy at Bhaktapur Cancer Hospital from 1st August 2013 to 31st December 2015. Received specimen was grossed following standard protocol and histopathological evaluation was done in relation to tumor type, depth of invasion, Lymphovascular and perineural invasion.Results: Pure urothelial carcinoma comprises 47.1% of cases. Among the divergent differentiation, urothelial carcinoma with squamous differentiation was the commonest one (39.2%) followed by glandular differentiation (5.9%), sarcomatoid differentiation (3.9%), clear cell variant (2.0%) and squamous along with sarcomatoid variant (2.0%). Statistical significant correlation was found between urothelial carcinoma with divergent differentiation and tumor stage (p<0.012). Statistically significant correlation was also found between urothelial carcinoma with divergent differentiation and lymphovascular invasion (p=0.012) as well as perineural invasion (p=0.037).Conclusion: Most common divergent differentiation was squamous differentiation. Urothelial carcinoma with divergent differentiation was associated with higher stage and lymphovascular as well as perineural invasion. So it is mandatory to search for the divergent differentiation in urothelial carcinoma as this may be associated with unfavourable prognosis.

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MP58-16 ONCOLOGIC OUTCOMES OF SQUAMOUS CELL CARCINOMA VERSUS UROTHELIAL CARCINOMA WITH SQUAMOUS DIFFERENTIATION AFTER RADICAL CYSTECTOMY FOR MUSCLE INVASIVE BLADDER CANCER (MIBC)

The Journal of Urology ◽

10.1016/j.juro.2017.02.1811 ◽

2017 ◽

Vol 197 (4S) ◽

Author(s):

Mahmoud Laymon ◽

Ahmed Mansour ◽

Mohamed M. Elsaadany ◽

Ahmed Mosbah ◽

Shaaban AA ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Bladder Cancer ◽

Urothelial Carcinoma ◽

Cell Carcinoma ◽

Radical Cystectomy ◽

Squamous Cell ◽

Oncologic Outcomes ◽

Squamous Differentiation ◽

Muscle Invasive Bladder Cancer ◽

Muscle Invasive

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1751 OUTCOMES IN PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR RECURRENT BLADDER CANCER FOLLOWING PRIOR PARTIAL CYSTECTOMY

The Journal of Urology ◽

10.1016/j.juro.2012.02.1767 ◽

2012 ◽

Vol 187 (4S) ◽

Author(s):

Ross A. Wopat ◽

Eila C. Skinner ◽

Anirban P. Mitra ◽

Jie Cai ◽

Gus Miranda ◽

...

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Partial Cystectomy ◽

Recurrent Bladder Cancer

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A Case of Primary Small-Cell Carcinoma of the Bladder

Case Reports in Oncology ◽

10.1159/000450597 ◽

2016 ◽

Vol 9 (3) ◽

pp. 574-579 ◽

Cited By ~ 1

Author(s):

Ashita Ono ◽

Yosuke Hirasawa ◽

Mitsumasa Yamashina ◽

Naoto Kaburagi ◽

Takashi Mima ◽

...

Keyword(s):

Bladder Cancer ◽

Urothelial Carcinoma ◽

Cell Carcinoma ◽

Radical Cystectomy ◽

Small Cell Carcinoma ◽

Distant Metastasis ◽

Small Cell ◽

Common Type ◽

Cell Of Origin ◽

Carcinoma Of The Bladder

Primary small-cell carcinoma arising from the bladder (SmCCB) is uncommon. It differs from urothelial carcinoma (UC), the most common type of bladder cancer, with respect to its cell of origin, biology, and prognosis. Biologically, prostatic SmCCB is much more aggressive than UC, and the prognosis for cases with distant metastasis is especially poor. We report here a case of primary SmCCB (cT3bN1M0) treated with radical cystectomy.

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Comparative Outcomes of Pure Squamous Cell Carcinoma and Urothelial Carcinoma With Squamous Differentiation in Patients Treated With Radical Cystectomy

The Journal of Urology ◽

10.1016/j.juro.2011.09.056 ◽

2012 ◽

Vol 187 (1) ◽

pp. 74-79 ◽

Cited By ~ 29

Author(s):

Behfar Ehdaie ◽

Alexandra Maschino ◽

Shahrokh F. Shariat ◽

Jorge Rioja ◽

Robert J. Hamilton ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Urothelial Carcinoma ◽

Cell Carcinoma ◽

Radical Cystectomy ◽

Squamous Cell ◽

Squamous Differentiation

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Gender as an independent prognostic factor for final tumor stage and overall survival in patients with muscle invasive bladder cancer treated with radical cystectomy

European Urology Supplements ◽

10.1016/s1569-9056(16)15048-1 ◽

2016 ◽

Vol 15 (5) ◽

pp. e1220

Author(s):

D. Gajewska ◽

A. Lemiński ◽

K. Kaczmarek ◽

J. Lisiński ◽

M. Puszyński ◽

...

Keyword(s):

Overall Survival ◽

Bladder Cancer ◽

Prognostic Factor ◽

Radical Cystectomy ◽

Tumor Stage ◽

Independent Prognostic Factor ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Muscle Invasive

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Risk group stratification in patients with micropapillary bladder cancer treated with radical cystectomy and/or neoadjuvant chemotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.7_suppl.302 ◽

2015 ◽

Vol 33 (7_suppl) ◽

pp. 302-302

Author(s):

Stephen Bentley Williams ◽

Mario Fernandez ◽

Daniel Levi Willis ◽

Rebecca Slack ◽

Arlene O. Siefker-Radtke ◽

...

Keyword(s):

Risk Factors ◽

Bladder Cancer ◽

Neoadjuvant Chemotherapy ◽

Urothelial Carcinoma ◽

Radical Cystectomy ◽

Clinical Stage ◽

Recursive Partitioning ◽

Risk Groups ◽

Preoperative Risk Factors ◽

Traditional Risk Factors

302 Background: Micropapillary bladder cancer (MPBC) is an aggressive variant of urothelial carcinoma. We have previously published clinical risk stratification groups for patients with conventional urothelial carcinoma and sought to identify if these were valid in patients with this variant histology. Methods: An IRB approved review of 1910 patients in our radical cystectomy database revealed 106 patients with preoperative diagnosis of ≤cT4aN0M0 MPBC between December 1992 and January 2012 who underwent upfront radical cystectomy (RC, n = 74) or neoadjuvant chemotherapy (NAC) followed by RC (n = 32). To determine whether patients with MPBC can be risk stratified using traditional risk factors, a recursive partitioning analysis (RPA) was performed. Results: In multivariate analyses, hydronephrosis (HR=3.1; p=0.01), and extent of MPBC at transurethral resection (TUR) (HR=1.9; p=0.04) were associated with shortened OS. In the reduced model, clinical stage also achieved significance (HR=2.8; p=0.03). Results were similar for DSS: hydronephrosis (HR=2.4, p=0.03), extent of MPBC (HR=2.1, p=0.03) and clinical stage (HR=4.7, p=0.02). Using the RPA analysis, following risk groups were identified according to OS or DSS: 1) cT1 disease with no hydronephrosis; 2) cT2 or higher with no hydronephrosis; or 3) hydronephrosis (with any cT stage). These groups corresponded to a low, intermediate and high-risk groups with 5-year OS and DSS rates of 85% and 91%, 50% and 57% and 16% and 17%, (p<0.001), respectively. We found these risk groups to hold true in those treated with NAC or upfront RC; those who received NAC trended towards better outcomes. Conclusions: In patients with MPBC, preoperative risk factors can help stratify patients into different risk groups similar to what is seen in patients with conventional UC. Presence of hydronephrosis is an especially ominous sign.

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Contemporary utilization trends and survival outcomes in patients undergoing radical cystectomy and bladder preservation therapy for muscle invasive bladder cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.2_suppl.387 ◽

2016 ◽

Vol 34 (2_suppl) ◽

pp. 387-387

Author(s):

David Cahn ◽

Elizabeth Handorf ◽

Michael Nordsiek ◽

Thomas M. Churilla ◽

Eric M. Horwitz ◽

...

Keyword(s):

Bladder Cancer ◽

Urothelial Carcinoma ◽

Radical Cystectomy ◽

Selection Criteria ◽

Cox Regression ◽

External Beam Radiotherapy ◽

Stage Ii ◽

Bladder Preservation ◽

Carcinoma Of The Bladder ◽

Muscle Invasive

387 Background: To compare overall survival (OS) in patients undergoing radical cystectomy (RC) and bladder preservation therapy (BPT) for muscle invasive urothelial carcinoma of the bladder. Methods: We conducted a retrospective, observational cohort study in which we reviewed the National Cancer Database (NCDB) to identify patients with analytic stage II-III (N0M0) urothelial carcinoma of the bladder from 2003-2011. BPT patients were stratified as any external beam radiotherapy (EBRT), definitive radiotherapy (RT) [50-80Gy], and definitive RT + chemotherapy. Treatment trends were evaluated using Pearson Chi-square tests. OS was compared between RC and BPT using unadjusted Kaplan Meier curves and Cox regression models adjusted for year of treatment, hospital volume, and patient/tumor characteristics using increasingly stringent selection criteria to identify those undergoing BPT. Results: Of the 603,298 patients with bladder cancer captured in the NCDB from 2003-2011, 9% (n = 54,518) had analytic stage II-III with urothelial histology. 51.1% (n = 27,843) of these patients were treated with RC (70.9%, n = 19,745) or BPT (29.1%, n = 8,098). Of the patients undergoing BPT, stratified by selection criteria, 26.9% (n = 2,176) and 15.0% (n = 1,215) were treated with definitive RT and definitive RT + chemotherapy, respectively. Following adjustment, improved survival in patients undergoing RC was noted regardless of BPT definition employed in multivariate analysis. However, we noted attenuated differences in OS using increasingly stringent definitions for BPT (EBRT: HR 2.2 [CI 2.15-2.29]; definitive RT: HR 1.94 [CI 1.74-2.14]; definitive RT + chemotherapy: HR 1.56 [CI 1.45-1.68]). Conclusions: In the NCDB, receipt of BPT was associated with decreased OS compared to RC in all patients with stage II-III urothelial carcinoma, in part due to selection biases. However, the use of increasingly stringent definitions of BPT attenuated the observed survival differences. Further randomized prospective controlled trials are needed to compare trimodal BPT to RC to identify optimal candidates for bladder preservation.

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Clinical outcomes of patients with histologic variants of urothelial carcinoma treated with tetra-modality bladder-sparing protocol incorporating consolidative partial cystectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.6_suppl.490 ◽

2018 ◽

Vol 36 (6_suppl) ◽

pp. 490-490 ◽

Cited By ~ 1

Author(s):

Toshiki Kijima ◽

Soichiro Yoshida ◽

Minato Yokoyama ◽

Junichiro Ishioka ◽

Yoh Matsuoka ◽

...

Keyword(s):

Bladder Cancer ◽

Urothelial Carcinoma ◽

Response Rate ◽

Partial Cystectomy ◽

World Health ◽

Locoregional Control ◽

Cancer Specific Survival ◽

Muscle Invasive ◽

Health Organization ◽

Bladder Sparing

490 Background: Trimodality bladder-sparing therapy has become an accepted treatment for selected patients with muscle-invasive bladder cancer (MIBC). As some of the histologic variants of urothelial carcinoma (VUC) are more resistant to chemotherapy and radiotherapy compared with pure urothelial carcinoma (PUC), it is still controversial whether bladder-sparing therapy provides comparable disease control in VUC. We have developed a tetra-modality bladder-sparing therapy consisting of maximal transurethral resection (TUR), chemoradiotherapy (CRT), and consolidative partial cystectomy, which has theoretical advantage in locoregional control by surgically eliminating chemo- and radio-resistant cells (Koga et al, Urol Oncol 2013, BJU Int 2012). Methods: After maximal TUR and CRT (40Gy + cisplatin), treatment response was evaluated by cytology, imaging and tumor-site rebiopsy. Complete responders were candidate for consolidative partial cystectomy, while radical cystectomy was recommended for others. VUC identified in maximal TUR samples were categorized according to the 2004 World Health Organization Classification. Response rate to CRT, MIBC recurrence-free survival and cancer-specific survival (CSS) were compared between patients with PUC and VUC. Results: Between 1997 and 2016, 153 consecutive patients with cT2-3N0M0 bladder cancer (median age 69, female/male = 33/120, cT2/3 = 99/54) entered tetra-modality bladder-sparing protocol. VUC was identified in 37 (24%) of the patients, including glandular in 12 (8%), squamous in 11 (7%), micropapillary in 8 (5%), sarcomatoid in 2 (1%), microcystic in 2 (1%), and lymphoepithelioma-like in 1 (0.7%). There was no difference in the response rate to CRT between PUC and VUC (71% vs 84%, p = 0.13). Among the patients with PUC (n = 75) and VUC (n = 31) who underwent partial cystectomy, 5-yr MIBC recurrence-free rates were 92% and 100% (p = 0.21), and 5-yr CSS rates were 93% and 94% (p = 0.64), respectively. Conclusions: Tetra-modality bladder-sparing therapy incorporating partial cystectomy could provide favorable locoregional control and survival for patients with VUC.

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