title: Pure but Not Mixed Histologic Variants Are Associated With Poor Survival at Radical Cystectomy in Bladder Cancer Patients.
abstract: To evaluate the impact of pure and mixed histologic variant versus pure urothelial carcinoma in nonmetastatic bladder cancer (BCa) patients treated with radical cystectomy (RC).
  
  
  
  We evaluated data from 1067 patients treated with RC and pelvic lymph node dissection between 1990 and 2013 at a single institution tertiary-care referral center. All specimens were evaluated by dedicated uropathologists. Univariable and multivariable Cox regression analyses tested the impact of the presence of pure and mixed histologic variants versus pure urothelial on recurrence, cancer-specific mortality, and overall mortality after accounting for all available confounders.
  
  
  
  In total, 201 (19%) and 137 (13%) patients were found with mixed and pure variants at RC, respectively. Mixed preponderant variants were sarcomatoid, lymphoepitelial, squamous, and glandular; small-cell and micropapillary variants were found mostly as pure variants. With a median follow-up of 6.5 years, patients who harbored pure variant were found by multivariable analyses to have lower survival outcomes compared to pure urothelial carcinoma (all P < .01). Conversely, no differences were found between mixed variant versus pure urothelial by multivariable Cox regression analyses predicting recurrence, cancer-specific mortality, and overall mortality (all P > .1).
  
  
  
  The presence of histologic variants at RC is a common finding, accounting for approximately 30% of specimens. In this setting, the presence of a pure variant but not the presence of mixed variant with urothelial carcinoma is related to a detrimental effect on survival outcomes after RC.
authors.affiliation: Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, Urological Research Institute, Milan, Italy; Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy; Department of Urology, Medical University of Vienna, Vienna, Austria. Electronic address: marco.moschini87@gmail.com.
authors.forename: Marco
authors.initials: M
authors.lastname: Moschini
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria.
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.affiliation: Department of Pathology, Ospedale San Raffaele, Milan, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Lucianò
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria.
authors.forename: David
authors.initials: D
authors.lastname: D'Andrea
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria.
authors.forename: Beat
authors.initials: B
authors.lastname: Foerster
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Abufaraj
authors.affiliation: Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, Urological Research Institute, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Bandini
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria.
authors.forename: Paolo
authors.initials: P
authors.lastname: Dell'Oglio
authors.affiliation: Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Damiano
authors.affiliation: Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, Urological Research Institute, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Salonia
authors.affiliation: Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, Urological Research Institute, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, Urological Research Institute, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.affiliation: Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, Urological Research Institute, Milan, Italy.
authors.forename: Renzo
authors.initials: R
authors.lastname: Colombo
authors.affiliation: Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, Urological Research Institute, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gallina
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000473:pathology* / Q000601:surgery*; D015653:Cystectomy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*
keywords: Bladder cancer; Histological variants; Mixed variants; Radical cystectomy; Urothelial carcinoma