Impact of Histopathological Variant on the Outcome of Patients Treated by Radical Cystectomy

Abstract

PurposeIt is well established that muscle-invasive urothelial carcinoma (UC) has a marked propensity for divergent differentiation, a fact that has significant diagnostic, prognostic, and therapeutic implications. This work is designed to assess the impact of different histopathologic variants of bladder cancer on morbidity and mortality in patients undergoing radical cystectomy (RC) as compared to the impact in patients with conventional UC.Materials and MethodsWe reviewed records of 201 patients treated with RC and pelvic lymph node dissections. Demographics as well as clinico-pathologic parameters, including histopathological variant, tumor stage, and nodal status, were reviewed. Multivariate analyses were used to evaluate these parameters for overall survival (OS). Kaplan-Meier curves for overall and cancer-specific survival were plotted.ResultsThe majority of patients were male (84%), and the mean age was 61±13.1 years (range, 27-87 years). The mean follow-up was 67 months (range, 6-132 months). A histological variant of UC tumor was found in 19 patients (11%). The OS was 55%, and the cancer-specific survival was 35%. The histopathologic variance showed significant impact on morbidity and mortality (p=0.02 and p=0.05, respectively). Patients with divergent histopathology of bladder tumor have poorer survival than do those with UC in a multivariate analysis.ConclusionsThe pathologic stages at RC and lymph node involvement are predictors for OS. Because of its aggressive nature, histopathologic variance is an independent risk factor determining the outcome in terms of both morbidity and mortality.

The Impact of Histological Variants on Oncological Outcomes in Patients with Muscle Invasive Bladder Cancer Treated with Radical Cystectomy

“…However, the number of variants in that study was limited to 19 patients. 8 In Böyük et al’s study of 223 patients undergoing radical cystectomy, pathologic stage of disease, and presence of VH were found to be associated with lower CSS in the multivariate model. 9 In a meta-analysis of 23 studies involving 22 072 patients, VH was significantly associated with worse CSS (pooled HR 1.37, 95% CI).…”

“…There are studies showing that VH is associated with poorer survival on multivariate analysis. Nadeem et al 8 evaluated 201 patients that underwent RC and showed that age, gender distribution, T stage, and nodal status were not significant in predicting survival in multivariate analysis, but variant pathology was an independent risk factor for CSS. Variant pathology has also been shown to have a significant effect on OS in Cox regression analysis (hazard ratio (HR), 2.81; 95% confidence interval (CI), 1.32-5.97).…”