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Concordance and clinical significance of uncommon variants of bladder urothelial carcinoma in transurethral resection and radical cystectomy specimens      4/20/2016

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Cai T1, Tiscione D2, Verze P3, Pomara G4, Racioppi M5, Nesi G6, Barbareschi M7, Brausi M8, Gacci M9, Luciani LG2, Liguori G10, Gontero P11, Campodonico F12, Simonato A13, Boddi V14, Di Stasi SM15, Colombo R16, Serretta V17, Carmignani G13, Malossini G2, Altieri V18, Carini M9, Terrone C19, Bassi P5, Montorsi F16, Ficarra V20, Selli C21, Mirone V3, Bartoletti R22.
Author information
1Department of Urology, Santa Chiara Regional Hospital, Trento, Italy. Electronic address: ktommy@libero.it.
2Department of Urology, Santa Chiara Regional Hospital, Trento, Italy.
3Department of Urology, University Federico II, Naples, Italy.
4Urology Unit, Department of Endocrinology, S. Chiara Hospital, Pisa, Italy.
5Department of Urology, University of Sacro Cuore, Policlinico Gemelli, Rome, Italy.
6Department of Pathology and Oncology, University of Florence, Florence, Italy.
7Department of Pathology, Santa Chiara Regional Hospital, Trento, Italy.
8Department of Urology, New S. Agostino and Estense Hospital, Modena, Italy.
9Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.
10Department of Urology, University of Trieste, Trieste, Italy.
11Department of Urology, University of Turin, Turin, Italy.
12Urology Unit, Department of Specialty Surgery, EO Ospedali Galliera, Genoa, Italy.
13Department of Urology 'L. Giuliani', University of Genoa, Genoa, Italy.
14Department of Public Health, University of Florence, Florence, Italy.
15Department of Surgery/Urology, Tor Vergata University, Rome, Italy.
16Department of Urology, University Vita-Salute San Raffaele, Milan, Italy.
17Section of Urology, Maternal-Infant, Andrology and Urology Department, University of Palermo, Palermo, Italy.
18Department of Urology, University of Salerno, Salerno, Italy.
19Division of Urology, ASO Maggiore della Carità University Hospital, University of Eastern Piedmont, Novara, Italy.
20Department of Urology, University of Udine, Udine, Italy.
21Department of Urology, University of Pisa, Pisa, Italy.
22Department of Urology, Santa Maria Annunziata Hospital, University of Florence, Florence, Italy.
Abstract
OBJECTIVE:
To evaluate the concordance and prognostic role of histologic variants of bladder urothelial carcinoma in transurethral resection of bladder tumor (TURBT) and radical cystectomy (RC) specimens.
METHODS:
Clinicopathologic information available at the time of RC and follow-up data from 4110 RC specimens, collected between January 2000 and December 2009 at 17 tertiary referral centers were retrospectively analyzed and evaluated for the presence or absence of uncommon variants of bladder urothelial carcinoma. The presence or absence of uncommon variants of bladder urothelial carcinoma was evaluated on previous TURBT specimens of patients undergoing RC. Cox regression was used to assess the impact of these parameters on cancer-specific survival, and the Kaplan-Meier test for disease-free survival was plotted for survival estimate.
RESULTS:
Of 4110 patients, 579 were found to have uncommon variants of bladder urothelial carcinoma at RC (14.1%), whereas 266 (6.4%) at TURBT. A lack of agreement about uncommon variants was observed between TURBT and RC specimens in the entire population (P <.001). The presence of uncommon variants at TURBT was associated with an increased risk of pathologic upstage (hazard ratio, 3.24; confidence interval, 1.19-6.37; P <.003) and significant decrease in cancer-specific survival and recurrence-free survival (P <.001).
CONCLUSION:
Although the concordance of presence of uncommon histologic variants of urothelial bladder carcinoma between TURBT and RC is low, the presence of uncommon histologic variants of urothelial bladder carcinoma at TURBT is associated with a less favorable clinical outcome.

 
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