Introduction

To evaluate the impact of pure and mixed histological variant versus pure urothelial carcinoma in nonmetastatic bladder cancer (BCa) patients treated with radical cystectomy (RC) in a single institution center.

Methods

We evaluated data from 1,067 patients treated at a single institution with RC and pelvic lymph node dissection between 1990 and 2013 at a single institution tertiary care referral center. All specimen were evaluated by dedicated uropathologists. Univariable and multivariable Cox regression analyses tested the impact of the presence of pure and mixed histologic variants vs. pure urothelial and recurrence, CSM (cancer specific mortality) and OM (overall mortality) after accounting for all available confounders.

Results

In total, 201 (19%) and 137 (13%) patients were found with mixed and pure variant at RC, respectively. Mixed variant were preponderant in sarcomatoid, lymphoepitelial, squamous and glandular variants, on the other hand, 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 at multivariable_x000D_ analyses with lower survival outcomes when compared with pure urothelial carcinoma (all p<0.01). Conversely no differences were found between mixed variant vs. pure urothelial at multivariable Cox regression analyses predicting recurrence, CSM and OM (all p>0.1).

Conclusions

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.

Funding

none