Moschini Marco, Dell'Oglio Paolo, Luciano' Roberta, Gandaglia Giorgio, Soria Francesco, Mattei Agostino, Klatte Tobias, Damiano Rocco, Shariat Shahrokh F, Salonia Andrea, Montorsi Francesco, Briganti Alberto, Colombo Renzo, Gallina Andrea
Department of Urology, IRCCS Ospedale San Raffaele, URI Milan, Italy; Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy; Department of Urology, Medical University of Vienna, Vienna, Austria.
Department of Urology, IRCCS Ospedale San Raffaele, URI Milan, Italy.
Urol Oncol. 2017 Jun;35(6):335-341. doi: 10.1016/j.urolonc.2016.12.006. Epub 2017 Jan 10.
We sought to describe incidence of histological variants after radical cystectomy (RC) due to bladder cancer (BCa). Moreover, we investigated survival outcomes accounting for this parameter.
We retrospectively evaluated data from 1,067 patients with BCa treated with RC between 1990 and 2013 at a single tertiary care referral center. All specimen were evaluated by dedicated uropathologists. Univariable and multivariable Cox regression analyses tested the effect of different histopathological variant on recurrence, cancer-specific mortality (CSM), and overall mortality (OM) after accounting for all available confounders.
Of 1,067 patients, 729 (68.3%) harbored pure urothelial BCa while 338 (31.7%) were found to have a variant. Considering uncommon variants, 21 (2.0%) were sarcomatoid, 10 (0.9%) lymphoepitelial, 19 (1.8%) small cell, 109 (10.2%) squamous, 89 (8.3%) micropapillary, 23 (2.2%) glandular, 34 (3.2%) mixed variants, and 33 (3.1%) were found with other types of variants. With a median follow-up of 6.2 years, 343 recurrence, 365 CSM, and 451 OM were recorded, respectively. At multivariable Cox regression analyses, the presence of small cell variant was associated with higher recurrence (hazard ratio [HR] = 3.47, P<0.001), CSM (HR = 3.30, P<0.04), and OM (HR = 2.97, P<0.003) as compared with pure urothelial cancer. Conversely, no survival differences were recorded considering other histological variants (all P> 0.1).
Our study confirms that histological variant is not an infrequent event at RC specimen. However, in our single-center series, only patients found with small cell variant were associated with a negative effect on survival after RC.
我们试图描述因膀胱癌（BCa）行根治性膀胱切除术（RC）后组织学变异的发生率。此外，我们研究了考虑该参数后的生存结果。
我们回顾性评估了1990年至2013年间在一家三级医疗转诊中心接受RC治疗的1067例BCa患者的数据。所有标本均由专业泌尿病理学家进行评估。在考虑所有可用混杂因素后，单变量和多变量Cox回归分析测试了不同组织病理学变异对复发、癌症特异性死亡率（CSM）和总死亡率（OM）的影响。
在1067例患者中，729例（68.3%）患有单纯尿路上皮BCa，而338例（31.7%）存在变异。考虑罕见变异，21例（2.0%）为肉瘤样，10例（0.9%）为淋巴上皮样，19例（1.8%）为小细胞，109例（10.2%）为鳞状，89例（8.3%）为微乳头，23例（2.2%）为腺性，34例（3.2%）为混合变异，33例（3.1%）为其他类型变异。中位随访6.2年，分别记录到343例复发、365例CSM和451例OM。在多变量Cox回归分析中，与单纯尿路上皮癌相比，小细胞变异的存在与更高的复发率（风险比[HR]=3.47，P<0.001）、CSM（HR=3.30，P<0.04）和OM（HR=2.97，P<0.003）相关。相反，考虑其他组织学变异时未记录到生存差异（所有P>0.1）。
我们的研究证实组织学变异在RC标本中并非罕见事件。然而，在我们的单中心系列研究中，只有发现小细胞变异的患者在RC后生存方面受到负面影响。
