title: Concordance and clinical significance of uncommon variants of bladder urothelial carcinoma in transurethral resection and radical cystectomy specimens.
abstract: OBJECTIVE
  To evaluate the concordance and prognostic role of histologic variants of bladder urothelial carcinoma in transurethral resection of bladder tumor (TURBT) and radical cystectomy (RC) specimens.
  
  
  METHODS
  Clinicopathologic information available at the time of RC and follow-up data from 4110 RC specimens, collected between January 2000 and December 2009 at 17 tertiary referral centers were retrospectively analyzed and evaluated for the presence or absence of uncommon variants of bladder urothelial carcinoma. The presence or absence of uncommon variants of bladder urothelial carcinoma was evaluated on previous TURBT specimens of patients undergoing RC. Cox regression was used to assess the impact of these parameters on cancer-specific survival, and the Kaplan-Meier test for disease-free survival was plotted for survival estimate.
  
  
  RESULTS
  Of 4110 patients, 579 were found to have uncommon variants of bladder urothelial carcinoma at RC (14.1%), whereas 266 (6.4%) at TURBT. A lack of agreement about uncommon variants was observed between TURBT and RC specimens in the entire population (P <.001). The presence of uncommon variants at TURBT was associated with an increased risk of pathologic upstage (hazard ratio, 3.24; confidence interval, 1.19-6.37; P <.003) and significant decrease in cancer-specific survival and recurrence-free survival (P <.001).
  
  
  CONCLUSIONS
  Although the concordance of presence of uncommon histologic variants of urothelial bladder carcinoma between TURBT and RC is low, the presence of uncommon histologic variants of urothelial bladder carcinoma at TURBT is associated with a less favorable clinical outcome.
authors.affiliation: Department of Urology, Santa Chiara Regional Hospital, Trento, Italy. Electronic address: ktommy@libero.it.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Cai
authors.affiliation: Department of Urology, Santa Chiara Regional Hospital, Trento, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Tiscione
authors.affiliation: Department of Urology, University Federico II, Naples, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Verze
authors.affiliation: Urology Unit, Department of Endocrinology, S. Chiara Hospital, Pisa, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Pomara
authors.affiliation: Department of Urology, University of Sacro Cuore, Policlinico Gemelli, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Racioppi
authors.affiliation: Department of Pathology and Oncology, University of Florence, Florence, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Nesi
authors.affiliation: Department of Pathology, Santa Chiara Regional Hospital, Trento, Italy.
authors.forename: Mattia
authors.initials: M
authors.lastname: Barbareschi
authors.affiliation: Department of Urology, New S. Agostino and Estense Hospital, Modena, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Brausi
authors.affiliation: Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Gacci
authors.affiliation: Department of Urology, Santa Chiara Regional Hospital, Trento, Italy.
authors.forename: Lorenzo Giuseppe
authors.initials: LG
authors.lastname: Luciani
authors.affiliation: Department of Urology, University of Trieste, Trieste, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Liguori
authors.affiliation: Department of Urology, University of Turin, Turin, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Gontero
authors.affiliation: Urology Unit, Department of Specialty Surgery, EO Ospedali Galliera, Genoa, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Campodonico
authors.affiliation: Department of Urology 'L. Giuliani', University of Genoa, Genoa, Italy.
authors.forename: Alchiede
authors.initials: A
authors.lastname: Simonato
authors.affiliation: Department of Public Health, University of Florence, Florence, Italy.
authors.forename: Vieri
authors.initials: V
authors.lastname: Boddi
authors.affiliation: Department of Surgery/Urology, Tor Vergata University, Rome, Italy.
authors.forename: Savino M
authors.initials: SM
authors.lastname: Di Stasi
authors.affiliation: Department of Urology, University Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Renzo
authors.initials: R
authors.lastname: Colombo
authors.affiliation: Section of Urology, Maternal-Infant, Andrology and Urology Department, University of Palermo, Palermo, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Serretta
authors.affiliation: Department of Urology 'L. Giuliani', University of Genoa, Genoa, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Carmignani
authors.affiliation: Department of Urology, Santa Chiara Regional Hospital, Trento, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Malossini
authors.affiliation: Department of Urology, University of Salerno, Salerno, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Altieri
authors.affiliation: Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Carini
authors.affiliation: Division of Urology, ASO Maggiore della Carità University Hospital, University of Eastern Piedmont, Novara, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Terrone
authors.affiliation: Department of Urology, University of Sacro Cuore, Policlinico Gemelli, Rome, Italy.
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Bassi
authors.affiliation: Department of Urology, University Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: Department of Urology, University of Udine, Udine, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ficarra
authors.affiliation: Department of Urology, University of Pisa, Pisa, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Selli
authors.affiliation: Department of Urology, University Federico II, Naples, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Mirone
authors.affiliation: Department of Urology, Santa Maria Annunziata Hospital, University of Florence, Florence, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Bartoletti
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D015653:Cystectomy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*