Rare Tumors (May 2011)

Is radical cystectomy mandatory in every patient with variant histology of bladder cancer

  • Nandakishore Kamalakar Shapur,
  • Ran Katz,
  • Dov Pode,
  • Amos Shapiro,
  • Vladimir Yutkin,
  • Galina Pizov,
  • Liat Appelbaum,
  • Kevin C Zorn,
  • Mordechai Duvdevani,
  • Ezekiel H Landau,
  • Ofer N Gofrit

DOI
https://doi.org/10.4081/rt.2011.e22
Journal volume & issue
Vol. 3, no. 2
pp. e22 – e22

Abstract

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Urothelial carcinomas have an established propensity for divergent differentiation. Most of these "variant tumors" are muscle invasive but not all. The response of non muscle invasive variant tumors to intravesical immunotherapy with BCG is not established in the literature, and is reported here. Between June 1995 and December 2007, 760 patients (mean age of 67.5 years) underwent transurethral resection of first time bladder tumors in our institution. Histologically variant tumors were found in 79 patients (10.4%), 57 patients (72%) of them had muscle-invasive disease or extensive non-muscle invasive tumors and 22 patients (28%) were treated with BCG immunotherapy. These included 7 patients with squamous differentiation, 4 with glandular, 6 with nested, 4 with micropapillary and 1 patient with sarcomatoid variant. The response of these patients to immunotherapy was compared with that of 144 patients having high-grade conventional urothelial carcinomas. Median follow-up was 46 months. The 2 and 5-year progression (muscle-invasion) free survival rates were 92% and 84.24% for patients with conventional carcinoma compared to 81.06% and 63.16% for patients with variant disease (p=0.02). The 2 and 5-year disease specific survival rates were 97% and 91.43% for patients with conventional carcinoma compared to 94.74 % and 82% for patients with variant disease (p=0.33). 5 patients (22.7%) of variant group and 13 patients (9.03%) of conventional group underwent cystectomy during follow-up (p=0.068). Patients with non-muscle invasive variants of bladder cancers can be managed with intra-vesical immunotherapy if tumor is not bulky (>4cm). Although progression to muscle invasive disease is more common than in conventional group and occurs in about 40% of the patients. Life expectancy is similar to patients with conventional high-grade urothelial carcinomas provided that follow-up is meticulous.

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