The clinicopathological features and treatment outcomes of plasmacytoid variant (PV)-urothelial carcinoma of the bladder (UCB) have not been fully understood. We aimed to evaluate the clinicopathologic characteristics and survival outcomes of PV-UCB as compared to conventional UCB (C-UCB).
A systematic review was performed following the PRISMA guideline. PubMed/Medline, Embase, and Cochrane Library were searched up to June 2019. The differences in the clinicopathological features (≥stage pT3, lymph node metastasis, ureteral margin-positive, and perivesical soft tissue margin-positive status) and survival outcomes [overall mortality (OM) and cancer-specific mortality (CSM)] between PV-UCB and C-UCB were compared. The GRADE approach was used for rating the certainty of evidence.
A total of 8 studies were included. Patients with PV-UCB had a higher frequency of ≥stage pT3 (odds ratio [OR], 3.84; 95% confidence interval [CI], 1.63-9.03; p=0.002) and risk of lymph node metastasis (OR, 2.58; 95% CI, 1.15-5.76; p=0.02), ureteral margin-positive (OR 12.18; 95% CI, 4.62-32.13; p<0.00001), and perivesical soft tissue margin-positive (OR 12.31; 95% CI, 5.15-29.41; p<0.00001) status after radical cystectomy than those with C-UCB. Although there was no difference in CSM (hazard ratio [HR], 1.40; 95% CI, 0.82-2.40; p=0.22) between PV-UCB and C-UCB, PV-UCB had worse survival outcomes (OM) than C-UCB approaching the borderline of significance (HR, 1.62; 95% CI, 0.98-2.68; p=0.06) when adjusted for other clinicopathological characteristics.
PV-UCB was strongly associated with adverse clinicopathological features and worse OM compared to C-UCB after adjusting other clinicopathological parameters, and PV histology of UCB is an independent prognostic factor for overall survival.
The Journal of urology. 2020 Jan 31 [Epub ahead of print]
Do Kyung Kim, Jong Won Kim, Jae Y Ro, Hye Sun Lee, Ju-Young Park, Hyun Kyu Ahn, Joo Yong Lee, Kang Su Cho
Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea., Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea., Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, Texas., Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea., Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.