Tommaso Cai1, Daniele Tiscione2, Paolo Verze3, Giorgio Pomara4, Marco Racioppi5, Gabriella Nesi6, Mattia Barbareschi7, Maurizio Brausi8, Mauro Gacci9, Lorenzo Giuseppe Luciani2, Giovanni Liguori10, Paolo Gontero11, Fabio Campodonico12, Alchiede Simonato13, Vieri Boddi14, Savino M Di Stasi15, Renzo Colombo16, Vincenzo Serretta17, Giorgio Carmignani13, Gianni Malossini2, Vincenzo Altieri18, Marco Carini9, Carlo Terrone19, Pierfrancesco Bassi5, Francesco Montorsi16, Vincenzo Ficarra20, Cesare Selli21, Vincenzo Mirone3, Riccardo Bartoletti22. 1. Department of Urology, Santa Chiara Regional Hospital, Trento, Italy. Electronic address: ktommy@libero.it. 2. Department of Urology, Santa Chiara Regional Hospital, Trento, Italy. 3. Department of Urology, University Federico II, Naples, Italy. 4. Urology Unit, Department of Endocrinology, S. Chiara Hospital, Pisa, Italy. 5. Department of Urology, University of Sacro Cuore, Policlinico Gemelli, Rome, Italy. 6. Department of Pathology and Oncology, University of Florence, Florence, Italy. 7. Department of Pathology, Santa Chiara Regional Hospital, Trento, Italy. 8. Department of Urology, New S. Agostino and Estense Hospital, Modena, Italy. 9. Department of Urology, Careggi Hospital, University of Florence, Florence, Italy. 10. Department of Urology, University of Trieste, Trieste, Italy. 11. Department of Urology, University of Turin, Turin, Italy. 12. Urology Unit, Department of Specialty Surgery, EO Ospedali Galliera, Genoa, Italy. 13. Department of Urology 'L. Giuliani', University of Genoa, Genoa, Italy. 14. Department of Public Health, University of Florence, Florence, Italy. 15. Department of Surgery/Urology, Tor Vergata University, Rome, Italy. 16. Department of Urology, University Vita-Salute San Raffaele, Milan, Italy. 17. Section of Urology, Maternal-Infant, Andrology and Urology Department, University of Palermo, Palermo, Italy. 18. Department of Urology, University of Salerno, Salerno, Italy. 19. Division of Urology, ASO Maggiore della Carità University Hospital, University of Eastern Piedmont, Novara, Italy. 20. Department of Urology, University of Udine, Udine, Italy. 21. Department of Urology, University of Pisa, Pisa, Italy. 22. Department 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.
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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