title: Micropapillary bladder cancer: current treatment patterns and review of the literature.
abstract: OBJECTIVE
  No guidelines exist for the management of micropapillary bladder cancer (MPBC) and most reports of this variant of urothelial carcinoma are case series comprising small numbers of patients. We sought to determine current practice patterns for MPBC using a survey sent to the Society of Urologic Oncology (SUO) and to present those results in the setting of a comprehensive review of the existing literature.
  
  
  METHODS
  A survey developed by the Translational Science Working Group of the Bladder Cancer Advocacy Network-sponsored Think Tank meeting was distributed to members of the SUO. The results from 118 respondents were analyzed and presented with a literature review.
  
  
  RESULTS
  Most survey respondents were urologists, with 80% considering bladder cancer their primary area of interest. Although 78% of the respondents reported a dedicated genitourinary pathologist at their institution, there were discrepant opinions on how a pathologic diagnosis of MPBC is determined as well as variability on the proportion of MPBC that is clinically significant. Among them, 78% treat MPBC differently than conventional urothelial carcinoma, with 81% reporting that they would treat cT1 MPBC with upfront radical cystectomy. However, the respondents had split opinions regarding the sensitivity of MPBC to cisplatin-based chemotherapy, which affected utilization of neoadjuvant chemotherapy in muscle-invasive disease.
  
  
  CONCLUSIONS
  The management of MPBC is diverse among members of the SUO. Although most favors early cystectomy for cT1 MPBC, there is no consensus on the use of neoadjuvant chemotherapy for muscle-invasive MPBC.
authors.affiliation: Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Willis
authors.affiliation: Division of Medical Oncology, University of Colorado Denver, School of Medicine, Denver, CO.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Flaig
authors.affiliation: Department of Pathology, UC San Diego, School of Medicine, San Diego, CA.
authors.forename: Donna E
authors.initials: DE
authors.lastname: Hansel
authors.affiliation: Division of Hematology/Oncology, University of North Carolina, School of Medicine, Chapel Hill, NC.
authors.forename: Matthew I
authors.initials: MI
authors.lastname: Milowsky
authors.affiliation: Division of Urologic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Grubb
authors.affiliation: Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York City, NY.
authors.forename: Hikmat A
authors.initials: HA
authors.lastname: Al-Ahmadie
authors.affiliation: Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Plimack
authors.affiliation: Department of Urology, Oregon Health and Science University, Portland, OR.
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Koppie
authors.affiliation: Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: David J
authors.initials: DJ
authors.lastname: McConkey
authors.affiliation: Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Colin P
authors.initials: CP
authors.lastname: Dinney
authors.affiliation: Bladder Cancer Advocacy Network, Bethesda, MD.
authors.forename: Vanessa A
authors.initials: VA
authors.lastname: Hoffman
authors.affiliation: Department of Urology, Mount Sinai Hospital, New York City, NY.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Droller
authors.affiliation: Department of Urology, University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, NY.
authors.forename: Edward
authors.initials: E
authors.lastname: Messing
authors.affiliation: Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: akamat@mdanderson.org.
authors.forename: Ashish M
authors.initials: AM
authors.lastname: Kamat
mesh_terms: D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D015653:Cystectomy / Q000379:methods; D006801:Humans; D008495:Medical Oncology / Q000706:statistics & numerical data*; D020360:Neoadjuvant Therapy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011878:Radiotherapy / Q000379:methods; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000628:therapy*
keywords: Bladder cancer; Micropapillary; Review; Survey