Variant Histology Predicts Worse Bladder Cancer Outcomes

Study finds a higher death risk following radical cystectomy for squamous cell and small cell carcinoma and micropapillary histologic subtypes.
Study finds a higher death risk following radical cystectomy for squamous cell and small cell carcinoma and micropapillary histologic subtypes.
The following article is part of conference coverage from the 2017 American Urological Association meeting in Boston. Renal and Urology News' staff will be reporting live on medical studies conducted by urologists and other specialists who are tops in their field in kidney stones, prostate cancer, kidney cancer, bladder cancer, enlarged prostate, and more. Check back for the latest news from AUA 2017. 

BOSTON—Variant histologic subtypes of bladder cancer are associated with worse overall survival compared with urothelial carcinoma (UC) of the bladder among patients who undergo radical cystectomy, researchers reported at the American Urological Association 2017 annual meeting.

“We looked at overall survival in patients with non-urothelial histology and we found that there were certain predictors of worse outcomes, and when we adjusted for all the other factors, squamous cell carcinoma and small cell carcinoma were associated with increased mortality,” lead investigator Renu Eapen, MD, a urologic oncology clinical fellow at the University of California San Francisco, told Renal & Urology News. “Interestingly, micropapillary [histology] was associated with slightly decreased risk.”

The findings may help clinicians provide more informed counseling of patients and aid in deciding when to start treatment, she said.

Using the National Cancer Database, Dr Eapen and her colleagues identified 105,211 patients (mean age 67 years) with bladder cancer treated with radical cystectomy. The most common variant histologic subtypes were squamous cell carcinoma (4.4%), small cell carcinoma (1.6%), and micropapillary (0.9%).

Compared with UC, squamous cell carcinoma and small cell carcinoma were independently associated with a significant 30% and 60% increased risk of death, respectively, and the micropapillary subtype was associated with a significant 20% decreased risk of death in adjusted analyses. Black race was independently associated with a 20% increased risk of death. All of these associations remained significant after controlling for age, gender, surgical margin status, pathologic T stage, pathologic N stage, and history of chemotherapy.

Variant histology was significantly more common among women than men (35.6% vs 23.4%), blacks compared with other races (8.8% vs 5.6%), those with stage pT3 or T4 disease compared with lower stages (67% vs 50.2%), and node positive disease (30.8% vs 26.9%).

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Reference

Eapen R, Washington S III, Sanford T, et al. Impact of histologic subtype on bladder cancer outcome. [abstract] J Urol 2017;197(S4):e113. Poster presented at the American Urological Association 2017 annual meeting in Boston on May 12. Poster MP10-13.

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