Clinical Outcomes in Bladder Cancer Patients with Histological Variants - Expert Commentary

Urothelial carcinoma (UC) is the most common histology of bladder cancer. Histological variants (HV) of bladder cancer are less common but frequently more aggressive. A recent paper published by Takemoto et al. in Anticancer Research studied the biological features and the prognostic value of HV in bladder cancer patients.

The researchers compared the oncological outcomes of UC patients with and without HV. The study included 102 patients who underwent radical cystectomy for UC between 1998 and 2017 for analysis. The median follow-up duration was 39.5 (18.0-70.5) months. The researchers found that 76 patients (74.5%) had pure UC, while HV was present in 26 patients (25.5%). Of these, 14 patients (13.7%) had squamous differentiation, 3 (2.9%) had glandular differentiation, 3 (2.9%) had mixed variants consisting of squamous and glandular differentiation, and 3 (2.9%) had small cell carcinoma. The presence of HV was associated with aggressive clinical behavior, including advanced tumor stage and vascular invasion (p<0.01) in comparison to pure UC.

Recurrence-free survival (RFS) was significantly lower in the HV group compared to pure UC (p=0.018). They also noted that 50% of patients in the HV group experienced disease recurrence compared to 27.6% of patients in the pure UC group. Similarly, cancer-specific survival (CSS) was significantly lower in the HV group compared to pure UC (p=0.036). In addition, 42.3% of patients with HV died of UC compared to 21.1% of patients with pure UC. Interestingly, there was no significant difference in overall survival between the two groups.

Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine, New York City, New York


  1. Takemoto, Kenshiro, Jun Teishima, Yuki Kohada, Kenichiro Ikeda, Hirotaka Nagamatsu, Akihiro Goriki, Shogo Inoue, Tetsutaro Hayashi, Mitsuru Kajiwara, and Akio Matsubara. "The Impact of Histological Variant on Oncological Outcomes in Patients With Urothelial Carcinoma of the Bladder Treated With Radical Cystectomy." Anticancer Research 40, no. 8 (2020): 4787-4793.
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