Abstract
BackgroundThe variant of urothelial carcinoma (UCV) is a rare and aggressive histological entity; its therapeutic management remains debated.MethodsBetween January 2017 and October 2019, 39 patients were diagnosed retrospectively with urothelial carcinoma with a histological variant. The aim of this study was to analyze the clinico-pathological and therapeutic aspects of these variants to better understand this invasive disease.ResultsIn 39 cases, 36 (92%) were men and 3 (8%) were women; the average age was 62 years; 54% of patients had a ≥ cT3 stage with clinical lymph node involvement in 28% and 23% had distant metastases, 36% of patients were treated with RC and 54% by other therapeutic and 10% refused RC. No patient received neoadjuvant chemotherapy. Lymph node involvement was 28.5%. The two predominant histological types were squamous and micropapillary differentiation between the operating piece and bladder biopsy 28.5%, 30% and 21.5% and 13%, respectively. The overall survival at 20 months was 70 and 40% for RC and the other therapeutic (TURB alone or a TURB with an adjuvant), respectively. There was no significant difference in survival between the two groups (p = 0.27).ConclusionUCVs are heterogeneous groups of tumors which are increasingly identified due to their distinct morphological characteristics with variable clinical prognosis. Therapeutic management is not in favor of cystectomy in our study. However, a prospective study using a larger cohort is still necessary to validate our results.
Highlights
The variant of urothelial carcinoma (UCV) is a rare and aggressive histological entity; its therapeutic management remains debated
Our patients were treated by a radical cystectomy (RC) or a transurethral resection of the bladder (TURB) alone or a transurethral resection of bladder (TURB) with an adjuvant treatment
The ISC was present in the bladder piece in 21.5% against 38% in the bladder biopsy, lymphovascular invasion (LVI) was present in the bladder piece in 28.5% compared to 46% in the bladder biopsy, and lymph node invasion was 28.5%
Summary
The variant of urothelial carcinoma (UCV) is a rare and aggressive histological entity; its therapeutic management remains debated. About 80% of the UBC is a pure or conventional urothelial carcinoma (UC), while the remaining 20% is represented by a divergent histological differentiation. The pathophysiological study of these variants has recently aroused growing interest, because the therapeutic approach is not uniform for all entities, for example, the effectiveness of NAC in the neuroendocrine variant [2,3,4,5]. These variants have important diagnostic, prognostic and therapeutic implications.
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