Impact of divergent differentiation in urothelial carcinoma on oncological outcome in patients with T1 high-grade bladder cancer.
OBJECTIVE
T1 high-grade bladder cancer has a poor prognosis compared with other non-muscle-invasive bladder cancers. We investigated the clinical outcomes among patients with T1 high-grade bladder cancer to identify factors related to cancer recurrence and disease progression.


METHODS
We retrospectively reviewed the data of 148 patients who were diagnosed with T1 high-grade bladder cancer by transurethral resection from January 2001 to February 2015 at our institution. Clinicopathological factors were analyzed using univariate and multivariate analyses.


RESULTS
The median age and follow-up duration were 72 years and 45.4 months, respectively. Sixty-two patients (41.9%) had recurrence, 28 (18.9%) experienced progression and 13 (8.8%) died of bladder cancer. In the multivariate analysis, divergent differentiation was an independent factor related to recurrence (P = 0.0096, hazard ratio = 2.5), whereas a non-papillary tumor shape, divergent differentiation and presence of a residual tumor at the time of the second transurethral resection were independent factors related to progression (P = 0.0349, hazard ratio = 3.8; P = 0.0074, hazard ratio = 6.8 and P = 0.0449, hazard ratio = 4.1, respectively). There were no independent factors related to cancer-specific mortality. Divergent differentiation was the only independent factor associated with both recurrence and progression. In addition, patients with divergent differentiation had significantly worse recurrence-free survival and progression-free survival rates than did patients without divergent differentiation (log-rank P = 0.0009 and P = 0.0019, respectively).


CONCLUSIONS
In this study, the presence of divergent differentiation was related to worse oncological outcomes in patients with T1 high-grade bladder cancer. Patients with divergent differentiation may require stringent follow-up and early cystectomy after recurrence to improve oncological outcomes.
Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi.
Nakanori
N
Fujii
Department of Diagnostic Pathology, Yamaguchi University Hospital, Ube, Yamaguchi.
Yoshinobu
Y
Hoshii
Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi.|Department of Urology, Ube Memorial Hospital, Ube, Yamaguchi, Japan.
Hiroshi
H
Hirata
Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi.
Junichi
J
Mori
Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi.
Kosuke
K
Shimizu
Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi.
Keita
K
Kobayashi
Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi.
Yoshihisa
Y
Kawai
Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi.
Ryo
R
Inoue
Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi.
Yoshiaki
Y
Yamamoto
Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi.
Hiroaki
H
Matsumoto
Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi.
Kazuhiro
K
Nagao
Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi.
Hideyasu
H
Matsuyama
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D018365:Neoplasm, Residual / Q000601:surgery; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology*; D019459:Urothelium / Q000473:pathology*
T1; divergent differentiation; high grade; non-muscle-invasive bladder cancer; urothelial carcinoma