Keiichiro Mori1,2, Mohammad Abufaraj1,3, Hadi Mostafaei1,4, Fahad Quhal1,5, Pierre I Karakiewicz6, Alberto Briganti7, Shoji Kimura1,2, Shin Egawa2, Shahrokh F Shariat1,3,8,9,10,11,12,13. 1. Department of Urology, Medical University of Vienna, Vienna, Austria. 2. Department of Urology, The Jikei University School of Medicine, Tokyo, Japan. 3. Division of Urology, Department of Special Surgery, The University of Jordan, Amman, Jordan. 4. Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. 5. Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia. 6. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada. 7. Department of Urology, Vita Salute San Raffaele University, Milan, Italy. 8. Department of Urology, Weill Cornell Medical College, New York, New York. 9. Department of Urology, University of Texas Southwestern, Dallas, Texas. 10. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria. 11. Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic. 12. Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia. 13. European Association of Urology Research Foundation, Arnhem, Netherlands.
Abstract
PURPOSE: The currently available evidence regarding the prognostic and clinical significance of each variant histology subtype of urothelial bladder cancer remains scarce. We assessed the prognostic value of variant histology in patients with urothelial carcinoma of the bladder treated with radical cystectomy. MATERIALS AND METHODS: PubMed®, Web of Science™, Cochrane Library and Scopus® databases were searched for articles published before October 2019 according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. We identified 39 studies comprising 20,544 patients matching our eligibility criteria. RESULTS: Studies were deemed eligible if they compared overall, cancer specific and recurrence-free survival in patients with urothelial carcinoma of the bladder with and without variant histology. Formal meta-analyses were performed for these outcomes. Variant histology was associated with worse cancer specific (pooled HR 1.37, 95% CI 1.24-1.50), overall (pooled HR 1.44, 95% CI 1.26-1.65) and recurrence-free survival (pooled HR 1.32, 95% CI 1.20-1.45). Subgroup analyses demonstrated that "micropapillary" (pooled HR 1.20, 95% CI 1.02-1.41), "plasmacytoid" (pooled HR 2.03, 95% CI 1.17-3.52) and "small cell" variant histology (HR 3.32, 95% CI 1.98-5.59) were also associated with worse overall survival. CONCLUSIONS: Variant histology in patients with urothelial carcinoma of the bladder is associated with increased risks of disease recurrence as well as cancer specific and overall mortality. Variant histology was independently associated with overall survival in the "micropapillary," "plasmacytoid" and "small cell" subgroups. Variant histology should be integrated into prognostic tools to guide risk stratification, treatment planning and patient counseling. However, caution should be exercised in interpreting the conclusions drawn from this study given the limitations, which include the heterogeneity of the population of interest and the retrospective nature of the primary data evaluated.
PURPOSE: The currently available evidence regarding the prognostic and clinical significance of each variant histology subtype of urothelial bladder cancer remains scarce. We assessed the prognostic value of variant histology in patients with urothelial carcinoma of the bladder treated with radical cystectomy. MATERIALS AND METHODS: PubMed®, Web of Science™, Cochrane Library and Scopus® databases were searched for articles published before October 2019 according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. We identified 39 studies comprising 20,544 patients matching our eligibility criteria. RESULTS: Studies were deemed eligible if they compared overall, cancer specific and recurrence-free survival in patients with urothelial carcinoma of the bladder with and without variant histology. Formal meta-analyses were performed for these outcomes. Variant histology was associated with worse cancer specific (pooled HR 1.37, 95% CI 1.24-1.50), overall (pooled HR 1.44, 95% CI 1.26-1.65) and recurrence-free survival (pooled HR 1.32, 95% CI 1.20-1.45). Subgroup analyses demonstrated that "micropapillary" (pooled HR 1.20, 95% CI 1.02-1.41), "plasmacytoid" (pooled HR 2.03, 95% CI 1.17-3.52) and "small cell" variant histology (HR 3.32, 95% CI 1.98-5.59) were also associated with worse overall survival. CONCLUSIONS: Variant histology in patients with urothelial carcinoma of the bladder is associated with increased risks of disease recurrence as well as cancer specific and overall mortality. Variant histology was independently associated with overall survival in the "micropapillary," "plasmacytoid" and "small cell" subgroups. Variant histology should be integrated into prognostic tools to guide risk stratification, treatment planning and patient counseling. However, caution should be exercised in interpreting the conclusions drawn from this study given the limitations, which include the heterogeneity of the population of interest and the retrospective nature of the primary data evaluated.
Authors: Keiichiro Mori; Takafumi Yanagisawa; Satoshi Katayama; Ekaterina Laukhtina; Benjamin Pradere; Hadi Mostafaei; Fahad Quhal; Pawel Rajwa; Marco Moschini; Francesco Soria; David D'andrea; Mohammad Abufaraj; Simone Albisinni; Wojciech Krajewski; Wataru Fukuokaya; Jun Miki; Takahiro Kimura; Shin Egawa; Jeremy Yc Teoh; Shahrokh F Shariat Journal: World J Urol Date: 2022-08-13 Impact factor: 3.661
Authors: Guglielmo Mantica; Stefano Tappero; Stefano Parodi; Nataniele Piol; Bruno Spina; Rafaela Malinaric; Federica Balzarini; Marco Borghesi; André Van Der Merwe; Nazareno Suardi; Carlo Terrone Journal: Cent European J Urol Date: 2021-09-09