Concordance and Clinical Significance of Uncommon Variants of Bladder Urothelial Carcinoma in Transurethral Resection and Radical Cystectomy Specimens

Cai, Tommaso; Tiscione, D.; Verze, Paolo; Pomara, Giorgio; Racioppi, Marco; Nesi, Gabriella; Barbareschi, Mattia; Brausi, Maurizio; Gacci, Mauro; Luciani, Lorenzo; Liguori, Giovanni; Gontero, Paolo; Campodonico, Fabio; Simonato, Alchiede; Boddi, Vieri; Stasi, Savino M. Di; Colombo, Renzo; Serretta, Vincenzo; Carmignani, G.; Malossini, G.; Altieri, Vincenzo; Carini, Marco; Terrone, Carlo; Bassi, Pierfrancesco; Montorsi, Francesco; Ficarra, Vincenzo; Selli, Cesare; Mirone, Vincenzo; Bartoletti, Riccardo

doi:10.1016/j.urology.2014.06.032

Cited by 47 publications

(22 citation statements)

References 26 publications

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“…In particular the concordance depended on the type of variant histology and was low in general and micropapillary variant, and high for sarcomatoid, small cell, and squamous variants. Similar result was shown in a multicenter study by Cai et al (22) who reported a lack of agreement for uncommon variants between TUR and RC in the entire population (P<0.001). However, Abufaraj et al (23), reported a high concordance rate between the two specimens (about 84%), with a TUR’s specificity of 99% and negative predictive value (NPV) of 83%.…”

Section: Accuracy Of Turbtsupporting

confidence: 89%

Histological variants in non-muscle invasive bladder cancer

Baumeister

Zamboni

Mattei

et al. 2019

Transl. Androl. Urol

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Several studies evaluated the role of histological variants on oncological outcomes after radical cystectomy (RC) and they were found significantly associated with worse recurrence and survival. Sparse data exists regarding the role variant histology in non-muscle invasive diseases: assessing their relationship with recurrence and progression is important to understand the most effective treatment and follow-up schedule. For these reasons, the aim of the present non-systematic review was to assess the literature on variant histology in non-muscle invasive bladder cancer (BCa). The diagnosis of presence variant histology at transurethral resection (TUR) specimens challenging for pathologists and several studies published in literature evaluated concordance between TUR and RC specimen with discordant results. These differences are probably related to diversity in collection of samples and pathological evaluation and underline the necessity to have good tissue-sample and a pathologic evaluation performed by expert and dedicated uropathologists. Treatment of BCa with variant histology shall include immediate RC in case of plasmacitoid, pure squamous, micropapillary and sarcomatoid variants. The neuroendocrine differentiation, therefore, showed chemosensitiveness, and RC preceded by neoadjuvant chemotherapy should be proposed. Intravesical instillations with Bacillus Calmette Guerin (BCG) can be suggested in very selected cases of nested and glandular variants.

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Section: Accuracy Of Turbtsupporting

confidence: 89%

Histological variants in non-muscle invasive bladder cancer

Baumeister

Zamboni

Mattei

et al. 2019

Transl. Androl. Urol

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“…In one multicenter study, more than half men with variant histology noted upon radical cystectomy specimen analysis were not diagnosed with variant histology at TURBT. [ 12 ]…”

Section: Discussionmentioning

confidence: 99%

Oncologic outcomes in patients with nonurothelial bladder cancer

et al. 2018

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Introduction:We aimed to evaluate the relative prognostic impact of the most common variant histologies on disease-specific survival (DSS) in patients undergoing radical cystectomy.Materials and Methods:The Surveillance, Epidemiology, and End Result database was used to identify patients who underwent radical cystectomy for bladder cancer from 1990 to 2007. Patients with urothelial cell carcinoma (UCC), squamous cell carcinoma (SCC), adenocarcinoma (AC), sarcoma, small cell carcinoma, signet ring carcinoma, and spindle cell carcinoma were included in the study. Multivariable analysis was performed using Cox proportional hazards model to assess independent predictors of disease-specific survival (DSS). Mortality rates were estimated using Kaplan–Meier analyses.Results:A total of 14,130 patients met inclusion criteria with the following histologies: UCC (90.1%), SCC (4.6%), AC, (2.3%), sarcoma (0.8%), small cell carcinoma (0.8%), signet ring carcinoma (0.5%), and spindle cell carcinoma (0.9%). Three-year DSS was most favorable in patients with UCC (63.7%; 95% confidence interval [62.9%–64.8%]) and AC (65.3% [59.3%–70.6%]), whereas 3-year DSS was the least favorable for small cell carcinoma (41.6% [31.3%–51.6%]) and sarcoma (45.4% [35.1%–55.1%]). In the multivariable analysis, independent predictors of DSS were age, marital status, grade, T-stage, N-stage, and variant histology. With respect to UCC, there was an increased risk of disease-specific death associated with all variants except AC. Sarcoma and spindle cell carcinoma were associated with the highest risk of death.Conclusions:With the exception of AC, the most common variant bladder cancer histologies are all independently associated with worse DSS relative to UCC in patients undergoing radical cystectomy.

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“…Approximately, 10-25% of bladder cancers have a component of variant histology [47][48][49][50]. The World Health Organization and International Consultation on Bladder Cancer recognizes more than 10 unique histologic variants in bladder cancer [46,51], summarized in Table 3.…”

Section: Pathologymentioning

confidence: 99%

“…Pure variant histology in particular may confer a distinct clinical behavior and tends to have a high propensity for relapse [52][53][54]. Variant histology is often challenging to identify on TURBT specimens [48,55]. As a result, pathology review by an experienced GU pathologist can be informative, and lead to major changes in management [43,44].…”

Section: Pathologymentioning

confidence: 99%

Current Management of Localized Muscle-Invasive Bladder Cancer: A Consensus Guideline from the Genitourinary Medical Oncologists of Canada

Jiang

North

Canil

et al. 2020

BLC

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BACKGROUND: Despite recent advances in the management of muscle-invasive bladder cancer (MIBC), treatment outcomes remain suboptimal, and variability exists across current practice patterns. OBJECTIVE: To promote standardization of care for MIBC in Canada by developing a consensus guidelines using a multidisciplinary, evidence-based, patient-centered approach who specialize in bladder cancer. METHODS: A comprehensive literature search of PubMed, Medline, and Embase was performed; and most recent guidelines from national and international organizations were reviewed. Recommendations were made based on best available evidence, and strength of recommendations were graded based on quality of the evidence. RESULTS: Overall, 17 recommendations were made covering a broad range of topics including pathology review, staging investigations, systemic therapy, local definitive therapy and surveillance. Of these, 10 (59% ) were level 1 or 2, 7 (41% ) were level 3 or 4 recommendations. There were 2 recommendations which did not reach full consensus, and were based on majority opinion. This guideline also provides guidance for the management of cisplatin-ineligible patients, variant histologies, and bladder-sparing trimodality therapy. Potential biomarkers, ongoing clinical trials, and future directions are highlighted. CONCLUSIONS: This guideline embodies the collaborative expertise from all disciplines involved, and provides guidance to further optimize and standardize the management of MIBC.

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Concordance and Clinical Significance of Uncommon Variants of Bladder Urothelial Carcinoma in Transurethral Resection and Radical Cystectomy Specimens

Cited by 47 publications

References 26 publications

Histological variants in non-muscle invasive bladder cancer

Histological variants in non-muscle invasive bladder cancer

Oncologic outcomes in patients with nonurothelial bladder cancer

Current Management of Localized Muscle-Invasive Bladder Cancer: A Consensus Guideline from the Genitourinary Medical Oncologists of Canada

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