Abstract
Purpose
Micropapillary (MP) bladder cancer is a rare variant of urothelial carcinoma (UC) which has been associated with an aggressive natural history. We sought to report the outcomes of patients with MP bladder cancer treated with radical cystectomy (RC) and compare survival to patients with pure UC of the bladder.
Methods
We identified 73 patients with MP bladder cancer and 748 patients with pure UC who underwent RC at our institution with median postoperative follow-up of 9.6 years. MP patients were stage-matched 1:2 to patients with pure UC. Survival was estimated using the Kaplan–Meier method and compared with the log-rank test.
Results
MP cancers were associated with a high rate of adverse pathologic features, as 48/73 patients (66 %) had pT3/4 tumors and 37 (50 %) had pN+ disease. Ten-year cancer-specific survival in MP patients was 31 %, compared with 53 % in the overall cohort with pure UC (p = 0.001). When patients with MP bladder cancer were then stage-matched to those with pure UC, no significant differences between the groups were noted with regard to 10-year local recurrence-free survival (62 vs. 69 %; p = 0.87), distant metastasis-free survival (44 vs. 56 %; p = 0.54), or cancer-specific survival (31 vs. 40 %; p = 0.41).
Conclusion
MP cancers are associated with a higher rate of locally advanced disease. However, when matched to patients with pure UC, patients with MP tumors did not have increased local/distant recurrence or adverse cancer-specific survival following RC.
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Abbreviations
- MP:
-
Micropapillary
- RC:
-
Radical cystectomy
- UC:
-
Urothelial carcinoma
- ECOG:
-
Eastern Cooperative Oncology Group
- BCG:
-
Bacillus Calmette-Guerin
- IQR:
-
Interquartile range
- TUR:
-
Transurethral resection
- CSS:
-
Cancer-specific survival
References
Siegel R, Naishadham D, Jemal A (2012) Cancer statistics. CA Cancer J Clin 62(1):10–29. doi:10.3322/caac.20138
Black PC, Brown GA, Dinney CP (2009) The impact of variant histology on the outcome of bladder cancer treated with curative intent. Urol Oncol 27(1):3–7. doi:10.1016/j.urolonc.2007.07.010
Amin MB, Ro JY, el-Sharkawy T, Lee KM, Troncoso P, Silva EG, Ordonez NG, Ayala AG (1994) Micropapillary variant of transitional cell carcinoma of the urinary bladder. Histologic pattern resembling ovarian papillary serous carcinoma. Am J Surg Pathol 18(12):1224–1232
Johansson SL, Borghede G, Holmang S (1999) Micropapillary bladder carcinoma: a clinicopathological study of 20 cases. J Urol 161(6):1798–1802. doi:10.1016/S0022-5347(05)68807-6
Alvarado-Cabrero I, Sierra-Santiesteban FI, Mantilla-Morales A, Hernandez–Hernandez DM (2005) Micropapillary carcinoma of the urothelial tract. A clinicopathologic study of 38 cases. Ann Diagn Pathol 9(1):1–5. doi:10.1053/j.anndiagpath.2004.10.001
Shah RB, Montgomery JS, Montie JE, Kunju LP (2012) Variant (divergent) histologic differentiation in urothelial carcinoma is under-recognized in community practice: impact of mandatory central pathology review at a large referral hospital. Urol Oncol. doi:10.1016/j.urolonc.2012.04.009
Ghoneim IA, Miocinovic R, Stephenson AJ, Garcia JA, Gong MC, Campbell SC, Hansel DE, Fergany AF (2011) Neoadjuvant systemic therapy or early cystectomy? Single-center analysis of outcomes after therapy for patients with clinically localized micropapillary urothelial carcinoma of the bladder. Urology 77(4):867–870. doi:10.1016/j.urology.2010.11.043
Edgerton N, Sirintrapun SJ, Munoz M, Chen Z, Osunkoya AO (2011) Micropapillary urothelial carcinoma of the urinary bladder: a clinicopathological analysis of 24 cases. Int J Urol 18(1):49–54. doi:10.1111/j.1442-2042.2010.02672.x
Lopez-Beltran A, Montironi R, Blanca A, Cheng L (2010) Invasive micropapillary urothelial carcinoma of the bladder. Hum Pathol 41(8):1159–1164. doi:10.1016/j.humpath.2009.11.018
Comperat E, Roupret M, Yaxley J, Reynolds J, Varinot J, Ouzaid I, Cussenot O, Samaratunga H (2010) Micropapillary urothelial carcinoma of the urinary bladder: a clinicopathological analysis of 72 cases. Pathology 42(7):650–654. doi:10.3109/00313025.2010.522173
Kamat AM, Dinney CP, Gee JR, Grossman HB, Siefker-Radtke AO, Tamboli P, Detry MA, Robinson TL, Pisters LL (2007) Micropapillary bladder cancer: a review of the University of Texas M. D. Anderson Cancer Center experience with 100 consecutive patients. Cancer 110(1):62–67. doi:10.1002/cncr.22756
Kamat AM, Gee JR, Dinney CP, Grossman HB, Swanson DA, Millikan RE, Detry MA, Robinson TL, Pisters LL (2006) The case for early cystectomy in the treatment of nonmuscle invasive micropapillary bladder carcinoma. J Urol 175(3 Pt 1):881–885. doi:10.1016/S0022-5347(05)00423-4
Samaratunga H, Khoo K (2004) Micropapillary variant of urothelial carcinoma of the urinary bladder; a clinicopathological and immunohistochemical study. Histopathology 45(1):55–64. doi:10.1111/j.1365-2559.2004.01895.x
Amin A, Epstein J (2012) Noninvasive micropapillary urothelial carcinoma: a clinicopathologic study of 18 cases. Hum Pathol. doi:10.1016/j.humpath.2012.04.013
AJCC (2010) AJCC cancer staging manual, 7th edn. Springer, Chicago
Lotan Y, Gupta A, Shariat SF, Palapattu GS, Vazina A, Karakiewicz PI, Bastian PJ, Rogers CG, Amiel G, Perotte P, Schoenberg MP, Lerner SP, Sagalowsky AI (2005) Lymphovascular invasion is independently associated with overall survival, cause-specific survival, and local and distant recurrence in patients with negative lymph nodes at radical cystectomy. J Clin Oncol Off J Am Soc Clin Oncol 23(27):6533–6539. doi:10.1200/JCO.2005.05.516
Lotan TL, Ye H, Melamed J, Wu XR, Shih Ie M, Epstein JI (2009) Immunohistochemical panel to identify the primary site of invasive micropapillary carcinoma. Am J Surg Pathol 33(7):1037–1041. doi:10.1097/PAS.0b013e3181962dcd
Ching CB, Amin MB, Tubbs RR, Elson P, Platt E, Dreicer R, Fergany A, Hansel DE (2011) HER2 gene amplification occurs frequently in the micropapillary variant of urothelial carcinoma: analysis by dual-color in situ hybridization. Mod Pathol 24(8):1111–1119. doi:10.1038/modpathol.2011.69
Sangoi AR, Beck AH, Amin MB, Cheng L, Epstein JI, Hansel DE, Iczkowski KA, Lopez-Beltran A, Oliva E, Paner GP, Reuter VE, Ro JY, Shah RB, Shen SS, Tamboli P, McKenney JK (2010) Interobserver reproducibility in the diagnosis of invasive micropapillary carcinoma of the urinary tract among urologic pathologists. Am J Surg Pathol 34(9):1367–1376. doi:10.1097/PAS.0b013e3181ec86b3
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Wang, J.K., Boorjian, S.A., Cheville, J.C. et al. Outcomes following radical cystectomy for micropapillary bladder cancer versus pure urothelial carcinoma: a matched cohort analysis. World J Urol 30, 801–806 (2012). https://doi.org/10.1007/s00345-012-0976-0
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DOI: https://doi.org/10.1007/s00345-012-0976-0