BACKGR0UND - High-grade urothelial carcinomas (UCs) often show foci of variant differentiation. There is limited information in the literature about the response of these variant urothelial tumors to immunotherapy with bacillus Calmette-Guerin (BCG).
We compared the response, to treatment with BCG, of UC containing glandular, squamous, nested, and micropapillary types of differentiation to response of conventional non-muscle invasive high-grade UC.
METHODS - A total of 100 patients were diagnosed with variant histology urothelial cancer between June 1995 and December 2013. Forty-one patients with Ta or T1, confirmed by second look biopsies, received immunotherapy with BCG. Fourteen patients in this group were diagnosed with micropapillary differentiation, 13 patients with squamous differentiation, 9 patients with glandular differentiation, and 7 patients with nested variants. The control group included 140 patients with conventional high-grade UC. Both groups have been treated and followed similarly.
FINDINGS - Patients with variant tumors had similar clinical features to patients with conventional disease, including age, male to female ratio, stage, the presence of Tis, and median follow-up. Patients with variant tumors had a significantly worse prognosis compared to patients with conventional high-grade UC, including 5-year recurrence-free survival (63.5 Vs. 71.5%, p = 0.05), 5-year progression (≥T2)-free survival (60 Vs. 82.5%, p = 0.002), 5-year disease-specific survival (73 Vs. 92.5%, p = 0.0004), and overall survival (66 Vs. 89.5%, 0.05).
INTERPRETATION - patient with variant bladder cancer treated with intravesical immunotherapy has a 27% chance of dying from this disease within 5 years compared to 7.5% chance for a patient with conventional high-grade UC.
Frontiers in oncology. 2016 Mar 15*** epublish ***
Ofer N Gofrit, Vladimir Yutkin, Amos Shapiro, Galina Pizov, Kevin C Zorn, Guy Hidas, Ilan Gielchinsky, Mordechai Duvdevani, Ezekiel H Landau, Dov Pode
Department of Urology, Hadassah Hebrew University Medical Center , Jerusalem , Israel., Department of Urology, Hadassah Hebrew University Medical Center , Jerusalem , Israel., Department of Urology, Hadassah Hebrew University Medical Center , Jerusalem , Israel., Department of Pathology, Hadassah Hebrew University Medical Center , Jerusalem , Israel., Section of Urology, Department of Surgery , Montreal, QC , Canada., Department of Urology, Hadassah Hebrew University Medical Center , Jerusalem , Israel., Department of Urology, Hadassah Hebrew University Medical Center , Jerusalem , Israel., Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel; Department of Pathology, Hadassah Hebrew University Medical Center, Jerusalem, Israel., Department of Urology, Hadassah Hebrew University Medical Center , Jerusalem , Israel., Department of Urology, Hadassah Hebrew University Medical Center , Jerusalem , Israel.