TY - JOUR
T1 - The impact of variant histology on the outcome of bladder cancer treated with curative intent
AU - Black, Peter C.
AU - Brown, Gordon A.
AU - Dinney, Colin P.N.
N1 - Funding Information:
This work was supported by an AUA Foundation Grant (PCB), NIH T32 Training Grant (PCB and GAB), NIH Bladder Cancer SPORE CA91846 (CPND), and the NCI Cancer Center Core Grant CA16672.
PY - 2009/1
Y1 - 2009/1
N2 - Patient risk stratification is essential for optimal management of patients with bladder cancer. Risk status determines the application and timing of therapeutic interventions such as repeat transurethral resection, intravesical chemo- and immunotherapy, systemic chemotherapy, and radical cystectomy. One key factor in such risk stratification appears to be the presence of variant histologic patterns in the bladder tumor. More than 90% of tumors are conventional urothelial carcinoma, and the rest consist of urothelial carcinoma with aberrant differentiation (squamous/glandular differentiation, small cell carcinoma, sarcomatoid carcinoma, and micropapillary carcinoma) or nonurothelial carcinoma (squamous cell carcinoma and adenocarcinoma). In this review, we focus on the implications of aberrant differentiation on the management of patients with bladder cancer. All of the variant histologies portend a worse prognosis than pure urothelial carcinoma. Although radical cystectomy remains the mainstay of treatment in all forms of bladder cancer, we highlight the use of neoadjuvant chemotherapy in patients with subtypes responsive to such therapy.
AB - Patient risk stratification is essential for optimal management of patients with bladder cancer. Risk status determines the application and timing of therapeutic interventions such as repeat transurethral resection, intravesical chemo- and immunotherapy, systemic chemotherapy, and radical cystectomy. One key factor in such risk stratification appears to be the presence of variant histologic patterns in the bladder tumor. More than 90% of tumors are conventional urothelial carcinoma, and the rest consist of urothelial carcinoma with aberrant differentiation (squamous/glandular differentiation, small cell carcinoma, sarcomatoid carcinoma, and micropapillary carcinoma) or nonurothelial carcinoma (squamous cell carcinoma and adenocarcinoma). In this review, we focus on the implications of aberrant differentiation on the management of patients with bladder cancer. All of the variant histologies portend a worse prognosis than pure urothelial carcinoma. Although radical cystectomy remains the mainstay of treatment in all forms of bladder cancer, we highlight the use of neoadjuvant chemotherapy in patients with subtypes responsive to such therapy.
KW - Bladder cancer
KW - Carcinosarcoma
KW - Micropapillary carcinoma
KW - Sarcomatoid carcinoma
KW - Small cell carcinoma
KW - Urothelial carcinoma
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U2 - 10.1016/j.urolonc.2007.07.010
DO - 10.1016/j.urolonc.2007.07.010
M3 - Review article
C2 - 18367107
AN - SCOPUS:57849156199
SN - 1078-1439
VL - 27
SP - 3
EP - 7
JO - Urologic Oncology: Seminars and Original Investigations
JF - Urologic Oncology: Seminars and Original Investigations
IS - 1
ER -