Non-urothelial tumours of bladder – impact on oncological outcomes
Reviewed by Karthik Rajan

Non-urothelial bladder tumours are not very common and they are generally considered to be high risk tumours when compared to standard urothelial tumours. In this study the researchers analysed the oncological outcomes of patients with such histology in comparison to those with transitional cell carcinoma (TCC) of bladder. They did a retrospective analysis of 430 patients who had undergone a radical cystectomy between 2010 and 2017. The median follow-up was 45 months. They however excluded patients who had a pure non-urothelial cancer like squamous cell carcinoma (SCC). They found 73 (17%) of patients had a non-urothelial variant histology (NUVH) among which squamous differentiation (9.5%) was the commonest followed by glandular (3.0%). They found that NUVH was associated with both decreased overall survival (OS) (14% in two years and 23% at five years). In addition, they also found that these patients had a poor cancer specific survival as well (15% in two years and 21% at five years). Among the variants, squamous subtype was found to have the worst prognosis. They noted no association with lymph node positivity on multivariate analysis, but there was a significant association with increased tumour stage. The recurrence rate was also shown to be significantly higher in NUVH (43.8% vs. 25.4%, HR 1.71, 95% CI 1.06-2.75). These findings highlight the high risk and unpredictable nature of these tumours and patients should be counselled for early cystectomy along with potential for need of adjuvant therapy and poorer outcomes.

The impact of non‐urothelial variant histology on oncological outcomes following radical cystectomy.
Stroman L, Nair R, Russell B, et al.
BJU INTERNATIONAL
2019;124:418-23.