Prognostic impact of variant histology in bladder cancer: Would early and aggressive treatment shift the paradigm?

Autores da FMUP

• Ana Margarida Gonçalves Manso

  Autor

• Ana Marta Matos Silva

  Autor

• João Fernando Alturas Da Silva

  Autor

• Carlos Manuel Pires Martins Da Silva

  Autor

Participantes de fora da FMUP

• Ramos, P
• Mateus, A
• Botelho, F
• Pacheco-Figueiredo, L

Unidades de investigação

• Cirurgia e Fisiologia

• Medicina da Comunidade, Informação e Decisão em Saúde

Abstract

Introduction: Bladder cancer (BC) is an increasingly frequent malignancy worldwide. Several variant histologies (VH) have been described in BC with a distinct clinical behavior. Objectives: This study aims to assess the prognostic impact of VH in BC, comparing its outcomes to pure urothelial carcinoma PUC in both non-muscle invasive (NMIBC) and muscle-invasive (MIBC) settings. Methods: We included patients with primary BC, comparing those with VH with those with PUC, with an age and sex-matched proportion of 1:3, considering stage at diagnosis, recurrence-free, progression-free, and overall survival (OS). A total of 616 patients were included in the study, (460 UC and 151 VH). Results: After first TURBT, MIBC was present in 99 (64.1%) of patients with VH, and 95 (20.6%) with UC (p<0.001). Concerning NMIBC, we observed higher rates of progression to MIBC amid patients with VH (p=0.009). Nodal involvement (p=0.020) and metastatic disease (p<0.001) were significantly higher within the VH group. A higher OS was observed among patients with NMIBC of PUC (p<0.001). There were no statistically significant differences of metastasis-free survival and OS between VH and UC groups within the MIBC setting. Conclusion: We confirmed that VH presents a more aggressive clinical course compared to PUC. An earlier radical treatment within the NMIBC setting could increase the oncological outcomes of the VH patients. (c) 2024 Elsevier Inc. All rights reserved.

Keywords

• Urinary bladder neoplasms; Variant histology; Cystectomy; Risk stratification