Clinical Significance of Squamous Differentiation in Urothelial Carcinoma of the Bladder.

Minato A ，Noguchi H ，Tomisaki I ，Fukuda A ，Kubo T ，Nakayama T ，Fujimoto N ... -  《-》

The Significance of Squamous Histology on Clinical Outcomes and PD-L1 Expression in Bladder Cancer.

Gordetsky JB ，Montgomery KW ，Giannico GA ，Rais-Bahrami S ，Thapa P ，Boorjian S ，Frank I ，Cheville J ... -  《-》

The Impact of Plasmacytoid Variant Histology on the Survival of Patients with Urothelial Carcinoma of Bladder after Radical Cystectomy.

The clinical significance of the plasmacytoid variant (PCV) in urothelial carcinoma (UC) is currently lacking. To compare clinical outcomes of patients with any PCV with that of patients with pure UC treated with radical cystectomy (RC). We identified 98 patients who had pathologically confirmed PCV UC and 1312 patients with pure UC and no variant history who underwent RC at our institution between 1995 and 2014. Univariable and multivariable Cox regression and Cox proportional hazards regression to determine if PCV was associated with overall survival (OS). Patients with PCV UC were more likely to have advanced tumor stage (p=0.001), positive lymph nodes (p=0.038), and receive neoadjuvant chemotherapy than those with pure UC (46% vs 22%, p<0.0001). The rate of positive soft tissue surgical margins was over five times greater in the PCV UC group compared with the pure UC group (21% vs 4.1%, respectively, p<0.0001). Median OS for the pure UC versus the PCV patients were 8 yr and 3.8 yr, respectively. On univariable analysis, PCV was associated with an increased risk of overall mortality (hazard ratio=1.34, 95% confidence interval: 1.02-1.78, p=0.039). However, on multivariable analysis adjusted for age, sex, neoadjuvant chemotherapy received, lymph node status, pathologic stage, and soft margin status, the association between PCV and OS was no longer significant (hazard ratio=1.06, 95% confidence interval: 0.78, 1.43, p=0.7). This retrospective study is limited by the lack of pathological reanalysis, and the impact of other concurrent mixed histology cannot be determined in this study. Patients with PCV features have a higher disease burden at RC compared with those with pure UC. However, PCV was not an independent predictor of survival after RC on multivariable analysis, suggesting that PCV histology should not be used as an independent prognostic factor. Plasmacytoid urothelial carcinoma is a rare and aggressive form of bladder cancer. Patients with plasmacytoid urothelial carcinoma had worse adverse pathologic features, but this was not associated with worse overall mortality when compared with patients with pure urothelial carcinoma.

Li Q ，Assel M ，Benfante NE ，Pietzak EJ ，Herr HW ，Donat M ，Cha EK ，Donahue TF ，Bochner BH ，Dalbagni G ... -  《European Urology Focus》

Outcomes of squamous histology in bladder cancer: a population-based study.

Squamous cell carcinoma (SCC) of the bladder is an uncommon form of bladder cancer. Using a large population-based sample we sought to describe the outcomes of patients with squamous histology and to define the factors that influence prognosis in these patients. All incident cases of bladder cancer in Ontario undergoing cystectomy from 1994 to 2008 were identified. Electronic treatment records and detailed pathologic information were linked to the study data set. Patients were divided into 3 cohorts: pure SCC, urothelial carcinoma (UC) with squamous differentiation (UCSD), and pure UC. Cox modeling was performed to evaluate factors associated with overall survival (OS) and cancer-specific survival (CSS). There were identified 178, 325, and 2,884 cases of SCC, UCSD, and UC, respectively. The unadjusted 5-year OS for these groups were 33%, 28%, and 34%, respectively. Patients had higher rates of T3/4 disease with SCC (72%) and UCSD (73%) than those with UC (61%, P<0.001). There was no difference in node positivity among groups (20%, 27%, and 25%, P = 0.519). After adjusting for covariates, SCC did not portend a worse survival, at 5 years. However, SCC did result in a more rapid disease trajectory, with survival curves of SCC and UC crossing at the 5-year mark. Adjusted CSS/OS of UCSD was also not significantly different from UC. Among those patients with SCC, factors associated with CSS included age>70 (hazard ratio [HR] = 1.96, 95% CI: 1.16-3.30), T category≥3 (HR = 2.09, 95% CI: 1.24-3.50), N positive disease (HR = 2.59, 95% CI: 1.55-4.32), lymphovascular invasion (HR = 1.98, 95% CI: 1.13-3.47), and positive surgical margins (HR = 2.95, 95% CI: 1.47-5.93). After adjusting for patient and disease characteristics, we have found that SCC leads to a more rapid disease course with survival that is equivalent to UC by 5 years.

Izard JP ，Siemens DR ，Mackillop WJ ，Wei X ，Leveridge MJ ，Berman DM ，Peng Y ，Booth CM ... -  《-》

Squamous Differentiation Predicts Poor Response to Cisplatin-Based Chemotherapy and Unfavorable Prognosis in Urothelial Carcinoma of the Urinary Bladder.

The efficacy of chemotherapy on UCSD is not known. This study was conducted to investigate the efficacy of cisplatin-based chemotherapy and prognosis of patients with UC with or without SD of the bladder. Patients with invasive bladder cancer (clinical T3-4aN0M0) who were treated between March 2003 and March 2015 with 2 or 3 cycles of neoadjuvant chemotherapy followed by radical cystectomy were retrospectively evaluated. Treatment outcomes were compared for each pathologic type in UCSD and pure UC. The primary end point was pathologic response in the cystectomy specimens. Disease-free survival and overall survival were secondary end points. We evaluated 9 patients with UCSD and 29 patients with pure UC. In the cystectomy specimens, pathologic complete response without residual tumors was not seen in any patients with UCSD, but evident in 10 patients (34.5%) with pure UC. The proportion of pathologic downstaging was significantly lower in patients with UCSD than in those with pure UC (11.1% vs. 51.7%; P = .031). Patients with UCSD had poorer disease-free survival (P < .001) and overall survival (P = .001) than those with pure UC. On multivariate Cox regression analysis, SD in UC was an independent predictor of recurrence (hazard ratio, 4.43; 95% confidence interval, 1.44-13.6, P = .009) and mortality (hazard ratio, 3.51; 95% confidence interval, 1.11-11.1, P = .032). UCSD of the bladder is less sensitive to cisplatin-based chemotherapy and has poor prognosis.

Minato A ，Fujimoto N ，Kubo T 《-》