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Abstract
PurposeTo investigate the prognostic significance of squamous and/or glandular differentiation in urothelial carcinoma (UC).Materials and MethodsAmong 800 consecutive patients who underwent radical cystectomy or nephroureterectomy at our institution from January 1990 to December 2010, 696 patients were included for the analysis. Clinicopathologic variables were compared according to the presence of squamous and/or glandular differentiation and the tumor location.ResultsA total of 51 (7.3%) patients had squamous and/or glandular differentiation. Patients with squamous and/or glandular differentiation had higher pathological T stage (p<0.001) and grade (p<0.001) than those with pure form of UC. After the median follow-up of 55.2 months, 84 (24.6%) and 82 (23.1%) died of upper urinary tract UC and UC of bladder, respectively. Patients with squamous and/or glandular differentiation in upper urinary tract UC showed poorer cancer-specific survival (CSS) (p<0.001) and overall survival (OS) (p<0.001) than those with pure form in upper urinary tract UC (p<0.001), but not in UC of bladder (p = 0.178 for CSS and p = 0.172 for OS). On multivariate Cox regression analysis, squamous and/or glandular differentiation was an independent predictor of CSS (hazard ratio [HR] 1.76; 95% confidence interval [CI] 1.08–2.85, p = 0.023), but it was not associated with OS (HR 1.52; 95% CI 1.00–2.32, p = 0.051).ConclusionsThe presence of variant histology could be associated with poorer survival outcome in patients with UC. Squamous and/or glandular differentiation is associated with features of biologically aggressive disease and an independent predictor of CSS.
Highlights
Bladder cancer is the 4th leading cause of new cancer cases and 8th leading cause of cancer-related mortality in males in the United States [1]
Because little evidence exists in the literature about the prognostic significance of histological variants in urothelial carcinoma (UC), we investigated the prognostic significance of squamous and/or glandular differentiation in UC
Age and gender were not different according to the presence of the squamous and/or glandular differentiation
Summary
Bladder cancer is the 4th leading cause of new cancer cases and 8th leading cause of cancer-related mortality in males in the United States [1]. Bladder cancer accounted for 73,510 new cases of cancer and 14,880 cancer-related deaths in the United States during 2012 [1]. Bladder tumors are the most common malignancy of the urinary tract, while upper urinary tract carcinomas are relatively uncommon comprising 5–10% of all urinary tract carcinomas [2,3]. In the United States, 90% to 95% of bladder cancers are pure UC and the remaining consists of UC with histological variants or non-UC. Squamous differentiation is the most common histological variant of UC, constituting nearly 10% of bladder tumor, followed by glandular differentiation [4,5,6,7]
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