PD33-02 VARIANT HISTOLOGIC DIFFERENTIATION IN BLADDER CANCER TREATED WITH RADICAL CYSTECTOMY: INCIDENCE AND LONG TERM SURVIVAL IN A SINGLE INSTITUTION STUDY.

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive IV1 Apr 2016PD33-02 VARIANT HISTOLOGIC DIFFERENTIATION IN BLADDER CANCER TREATED WITH RADICAL CYSTECTOMY: INCIDENCE AND LONG TERM SURVIVAL IN A SINGLE INSTITUTION STUDY. Marco Moschini, Vito Cucchiara, Stefano Luzzago, Paolo Dell'Oglio, Giusy Burgio, Vincenzo Serretta, Shahrokh Francois Shariat, Andrea Salonia, Alberto Briganti, Francesco Montorsi, Renzo Colombo, and Andrea Gallina Marco MoschiniMarco Moschini More articles by this author , Vito CucchiaraVito Cucchiara More articles by this author , Stefano LuzzagoStefano Luzzago More articles by this author , Paolo Dell'OglioPaolo Dell'Oglio More articles by this author , Giusy BurgioGiusy Burgio More articles by this author , Vincenzo SerrettaVincenzo Serretta More articles by this author , Shahrokh Francois ShariatShahrokh Francois Shariat More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Renzo ColomboRenzo Colombo More articles by this author , and Andrea GallinaAndrea Gallina More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.711AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bladder cancer (BCa), may present with variant morphologic features that deviate from the urothelial common aspect. These characteristics that can be defined as pure or mixed variants may have prognostic and therapeutic implications. METHODS We retrospectively evaluated histopathological data from 1,067 BCa patients treated with radical cystectomy (RC) and PLND for BCa between 1990 and 2013 at a single tertiary care referral center. All specimen were evaluated by dedicated uropathologists. Uni- and multivariate Cox regression analyses tested the impact of different histopathological variant CSM (cancer specific mortality) and OM (overall mortality) after accounting for age at surgery, pathological N stage, use of perioperative chemotherapy, number of positive nodes, number of removed nodes, positive surgical margin, pathological T stage, lymph vascular invasion, use of adjuvant chemotherapy. RESULTS Of 1,067 patients, 756 (70.9%) harbored pure urothelial BCa while 311 (29.1%) were found to have a variant. Of these, 202 (64.9%) had a mixed variant and 109 (35.1%) a pure variant. Considering uncommon variants, 21 (6.8%) were sarcomatoid, 10 (3.2%) lymphoepitelial, 19 (6.1%) small cell, 4 (1.3%) plasmacitoid, 2 (0.6%) nested, 109 (35.0%) squamous, 89 (28.6%) micropapillary, 23 (7.4%) glandular and 34 (10.9%) multiple mixed. With a median follow up of 65 months, CSM and OM were recorded in 365 (34.2%), 451 (42.3%) patients, respectively. The OM was 47% vs. 53% vs. 59% for pure urothelial vs. mixed vs. pure variants, respectively (Log rank p=0.011). The 5-years CSM was 44% vs. 47% vs. 53% for pure urothelial vs. mixed vs. pure variants, respectively (Log rank p=0.019). At MVA Cox regression analyses, the presence of pure histological variant was associated with higher CSM (HR: 1.60, p<0.005) and OM (HR: 1.55, p<0.004) as compared to pure urothelial cancer. However, no differences were recorded when mixed variants vs. pure transitional were analyzed (all p>0.3). In details, neuroendocrine (HR 4.30, CI 2.02-9.13, p<0.001), micropapillary (HR: 4.35, p=0.02) and multiple mixed (HR: 1.73; p<0.03) variants were associated with higher CSM after RC. CONCLUSIONS Our study confirm the negative impact of histological variant on the prediction on both CSM and OM after RC. The presence of a pure histopathological variant represents a strong negative predictor of survival, while patients with mixed urothelial and variant histologies did not harbor an increased risk of CSM and OM, as compared to conventional urothelial cancer. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e766 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Marco Moschini More articles by this author Vito Cucchiara More articles by this author Stefano Luzzago More articles by this author Paolo Dell'Oglio More articles by this author Giusy Burgio More articles by this author Vincenzo Serretta More articles by this author Shahrokh Francois Shariat More articles by this author Andrea Salonia More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Renzo Colombo More articles by this author Andrea Gallina More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...