Bladder cancer (BC) is the tenth most commonly diagnosed malignancy worldwide. In approximately 25% of cases, it presents as a muscle-invasive disease, requiring a radical treatment. Traditionally, the mainstay of treatment has been radical cystectomy (RC), but in the last decade, bladder-sparing treatments have been gaining growing interest. In particular, trimodal therapy (TMT) seems to yield survival results comparable to RC with less morbidity and better quality of life (QoL) outcomes. In this scenario, we aimed at shedding light on the role of the histological subtypes (HS) of BC and their prognostic significance in muscle-invasive BC (MIBC), treated either surgically or with TMT. We performed a narrative review to provide an overview of the current literature on this topic. When compared with patients diagnosed with conventional urothelial carcinoma (UC) of the same disease stage, survival did not appear to be significantly worse across the reports. But when sub-analyzed for separate subtype, some appeared to be independently associated with adverse survival outcomes such as the micropapillary, plasmacytoid, small-cell, and sarcomatoid subtypes, whereas others did not. Moreover, the optimal management remains to be defined, also depending on the therapeutic susceptibility of each histology. From this perspective, multi-disciplinary assessment alongside the routine inclusion of such entities in randomized clinical trials appears to be essential.
Journal of clinical medicine. 2024 Jul 25*** epublish ***
Francesco Claps, Arianna Biasatti, Luca Di Gianfrancesco, Luca Ongaro, Gianluca Giannarini, Nicola Pavan, Antonio Amodeo, Alchiede Simonato, Alessandro Crestani, Alessia Cimadamore, Rodolfo Hurle, Laura S Mertens, Bas W G van Rhijn, Angelo Porreca
Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1006 BE Amsterdam, The Netherlands., Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy., Department of Oncological Urology, Veneto Institute of Oncology (IOV) IRCCS, 35128 Padua, Italy., Department of Urology, Royal Free London NHS Foundation Trust, London NW3 2QG, UK., Urology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy., Urology Clinic, Department of Precision Medicine in Medical, Surgical and Critical Care, University of Palermo, 90127 Palermo, Italy., Institute of Pathological Anatomy, Department of Medicine, University of Udine, 33100 Udine, Italy., Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy.