|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 — Patients with pure histologic variants of non-metastatic bladder cancer have poor survival following radical cystectomy (RC), investigators reported at the American Urological Association’s 2017 annual meeting.
In a study of 1067 patients who underwent RC with pelvic lymph node dissection from 1990 to 2013, Marco Moschini, MD, of Urological Research Institute in Milan, Italy, and colleagues found that 137 (13%) patients had a pure variant and 201 (19%) had mixed variants. Small cell and micropapillary variants often appeared pure. Conversely, sarcomatoid, lymphoepithelial, squamous, or glandular variants were often observed mixed with urothelial carcinoma.
Patients with a pure variant had significantly lower survival odds than those with pure urothelial carcinoma over a median 6.5 years of follow up. Mixed-variant patients, however, had similar survival. The investigators adjusted for a range of confounders.
Pure and mixed-variant patients also had greater odds of recurrence, likely due to adverse pathologic features associated with variants, such as higher stage cancer and lymph node invasion, Dr Moschini reported.
The importance of a correct histologic variant classification in therapeutic decision-making has been evaluated by several authors and recently has been highlighted in the fourth edition of the World Health Organization classification of the urothelial tract, Dr Moschini noted. Uropathologists should report when histologic variants are present and whether they are pure or mixed with urothelial carcinoma. Patients with variant histology possibly could benefit from specialized treatment.
Moschini M, Colombo R, Gandaglia G, et al. Pure but not mixed histological variants are associated with poor survival at radical cystectomy in bladder cancer patients. Poster presented at the American Urological Association’s 2017 annual meeting on May 14, 2017. Poster MP54-15.
Moschini M, Shariat SF, Lucianò R, et al. Pure but not mixed histologic variants are associated with poor survival at radical cystectomy in bladder cancer patients. Clin Genitourin Cancer. December 2016 [Epub] doi: 10.1016/j.clgc.2016.12.006