Delayed radical cystectomy (RC) for patients with variant histology urothelial carcinoma (UC) of the bladder increases the risk of death, according to investigators.

In a study comparing variant histology UC and pure UC, each 1-month delay in RC from the time of diagnosis was significantly associated with a 36% increased risk of death on multivariate analysis controlling for age, tumor stage, node status, and other variables, a team from the University of Southern California in Los Angeles led by Siamak Daneshmand, MD, reported in Urology. In addition, a delay of more than 12 weeks for RC from diagnosis was significantly associated with an almost 3.5-fold increased risk of death compared with RC performed 12 weeks or less after diagnosis.

Dr Daneshmand and his colleagues noted that pathologic variants had a propensity to present with more advanced disease compared with pure UC. This aggressive growth pattern may explain why patients with variant histology are more susceptible to delay-related adverse outcomes compared with those who have pure UC, according to the investigators.

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The study included 68 patients with variant histology and 295 with pure UC. Patients had median ages of 74 and 73 years, respectively, and a median follow-up time of 42.4 months.

The variant histology group was more likely than the pure UC group to have a higher clinical stage (cT3-4, 16.2% vs 7.8%) and pathologic stage (58.8% vs 30.2% for T3 and 13.2% vs 6.8% for T4 disease) and to be upstaged at RC (60.3% vs 31.2%). The variant histology and pure UC groups did not differ significantly in the median time to RC: 56 vs 55 days.


Lin-Brande M, Pearce SM, Ashrafi AN, et al. Assessing the impact of time to cystectomy for variant histology of urothelial bladder cancer. Urology. 2019.

doi: 10.1016/j.urology.2019.07.034