Department of Urology, The George Washington University School of Medicine and Health Sciences, Washington, DC.
Department of Urology, The George Washington University School of Medicine and Health Sciences, Washington, DC.
Clin Genitourin Cancer. 2024 Oct;22(5):102179. doi: 10.1016/j.clgc.2024.102179. Epub 2024 Jul 26.
Bladder cancer (BCa) with variant histology (VH) is notably aggressive and not as well studied as pure urothelial carcinoma (UC). The characteristics of variant BCa in the setting of metastatic disease may contribute to treatment response/resistance and subsequent disease progression. In this study, we sought to assess VH's impact on metastasis sites at presentation in metastatic BCa.
The National Cancer Database was queried from 2004 to 2019 to analyze cT1-4 cN0-3 cM1 patients with UC and VH BCa. The primary endpoint was the presence of metastasis to different organs. Binomial multivariable logistic regression was performed to determine the impact of VH on metastatic sites while controlling for multiple variables.
Total 6005 eligible patients diagnosed with either UC or VH were included. Patients with small cell histology, the second most common VH, were more likely to have liver metastasis (OR: 4.335) while less likely to have lung metastases (OR: 0.521). Squamous cell carcinoma decreased the odds of bone metastasis (OR: 0.449). Adenocarcinoma increased the odds of lung metastases (OR: 1.690). Micropapillary VH is less likely to metastasize to the lungs (OR: 0.182) but more likely to spread to nonregional lymph nodes (OR: 2.623). Sarcomatoid subtype did not exhibit a statistically significant variation in the odds ratio for any of the metastatic sites.
This study comprehensively analyzes the limited research regarding metastatic BCa and VH. Our analysis underscores each subtype exhibiting heterogeneous metastatic tropism. Importantly, these findings illustrate the role of routine somatic gene expression profiling to guide adequate staging and treatment intensification and to offer a foundation for future studies of VH BCa care.
膀胱癌（BCa）伴变异组织学（VH）侵袭性明显，不如纯尿路上皮癌（UC）研究充分。转移性疾病中变异型 BCa 的特征可能影响治疗反应/耐药性以及随后的疾病进展。本研究旨在评估 VH 在转移性 BCa 患者首发时转移部位的影响。
从 2004 年至 2019 年，国家癌症数据库（National Cancer Database）被查询，以分析 cT1-4 cN0-3 cM1 期 UC 和 VH BCa 患者。主要终点是不同器官转移的存在。在控制多个变量的情况下，采用二项式多变量逻辑回归来确定 VH 对转移部位的影响。
共纳入 6005 例符合条件的 UC 或 VH 患者。第二常见的 VH 小细胞组织学患者更有可能发生肝转移（OR：4.335），而肺转移的可能性较小（OR：0.521）。鳞状细胞癌降低了骨转移的几率（OR：0.449）。腺癌增加了肺转移的几率（OR：1.690）。微乳头状 VH 向肺部转移的几率较低（OR：0.182），但向非区域性淋巴结转移的几率较高（OR：2.623）。肉瘤样亚型在任何转移部位的比值比都没有表现出统计学上的显著差异。
本研究全面分析了有限的转移性 BCa 和 VH 研究。我们的分析强调了每个亚型表现出异质的转移倾向。重要的是，这些发现阐明了常规体细胞基因表达谱分析在指导充分分期和治疗强化以及为未来 VH BCa 护理研究提供基础方面的作用。
