What is it about?

This study evaluated variant histologies (VHs) in patients with invasive urothelial bladder cancer undergoing radical cystectomy. The cohort included 1082 patients from eight centers with cT1-4aN0M0 urothelial BCa. Univariable and multivariable Cox' regression analyses were used to assess the effect of different VHs on disease-specific survival. The study found that 27.5% of patients harbored a VH, and lymphoepithelioma-like VH was associated with the best survival trend after controlling for standard predictors. Sarcomatoid VH showed features of epithelial-to-mesenchymal transition and was associated with worse survival, while plasmacytoid and small-cell VHs were associated with worse DSS in the overall cohort. The study suggests that lymphoepithelioma-like VH might be associated with better DSS compared to pure urothelial carcinoma.

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Why is it important?

This research is important as it evaluates the impact of variant histologies (VHs) on disease-specific survival (DSS) in patients with invasive urothelial bladder cancer (BCa) undergoing radical cystectomy (RC). It analyses a large multi-institutional cohort of patients and provides valuable insights into the prognosis of different VHs. This information can help in the development of personalized treatment plans and improving patient outcomes. Key Takeaways: 1. This study analyzed a multi-institutional cohort of 1082 patients with urothelial bladder cancer undergoing radical cystectomy. 2. 27.5% of patients had variant histologies (VHs), with squamous differentiation being the most common. 3. After accounting for different pathological stages and clinicopathological predictors, only a few VHs had a different prognosis from pure urothelial carcinoma (UC). 4. Lymphoepithelioma-like VH might be associated with better DSS compared to pure UC, while plasmacytoid and small-cell VHs were associated with worse DSS. 5. The study found that sarcomatoid VH showed features of epithelial-to-mesenchymal transition, but its impact on survival was controversial and further evidence is needed to determine the treatment algorithm for sarcomatoid VH.

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This page is a summary of: Prognostic impact of variant histologies in urothelial bladder cancer treated with radical cystectomy, BJU International, February 2023, Wiley,
DOI: 10.1111/bju.15984.
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