Prognostic impact of histological discordance between transurethral resection and radical cystectomy

Ayumu Matsuda; Rikiya Taoka; Jun Miki; Ryoichi Saito; Wataru Fukuokaya; Shingo Hatakeyama; Takashi Kawahara; Yoichi Fujii; Minoru Kato; Tomokazu Sazuka; Takeshi Sano; Fumihiko Urabe; Soki Kashima; Hirohito Naito; Yoji Murakami; Makito Miyake; Kei Daizumoto; Yuto Matsushita; Takuji Hayashi; Junichi Inokuchi; Yusuke Sugino; Kenichiro Shiga; Noriya Yamaguchi; Hiroyuki Iio; Keiji Yasue; Takashige Abe; Shotaro Nakanishi; Masafumi Matsumura; Masato Fujii; Kiyoaki Nishihara; Hiroaki Matsumoto; Shuichi Tatarano; Koichiro Wada; Sho Sekito; Ryo Maruyama; Naotaka Nishiyama; Hiroyuki Nishiyama; Hiroshi Kitamura; Yoshiyuki Matsui; Japanese Urological Oncology Group

doi:10.1111/bju.16296

Prognostic impact of histological discordance between transurethral resection and radical cystectomy

BJU Int. 2024 Feb 12. doi: 10.1111/bju.16296. Online ahead of print.

Authors

Ayumu Matsuda¹, Rikiya Taoka², Jun Miki^{3

4}, Ryoichi Saito^{5

6}, Wataru Fukuokaya^{3

4}, Shingo Hatakeyama⁷, Takashi Kawahara⁸, Yoichi Fujii⁹, Minoru Kato¹⁰, Tomokazu Sazuka¹¹, Takeshi Sano⁶, Fumihiko Urabe^{3

12}, Soki Kashima¹³, Hirohito Naito¹⁴, Yoji Murakami¹⁵, Makito Miyake¹⁶, Kei Daizumoto¹⁷, Yuto Matsushita¹⁸, Takuji Hayashi¹⁹, Junichi Inokuchi²⁰, Yusuke Sugino²¹, Kenichiro Shiga²², Noriya Yamaguchi²³, Hiroyuki Iio²⁴, Keiji Yasue²⁵, Takashige Abe²⁶, Shotaro Nakanishi²⁷, Masafumi Matsumura²⁸, Masato Fujii²⁹, Kiyoaki Nishihara³⁰, Hiroaki Matsumoto³¹, Shuichi Tatarano³², Koichiro Wada³³, Sho Sekito³⁴, Ryo Maruyama³⁵, Naotaka Nishiyama³⁶, Hiroyuki Nishiyama⁸, Hiroshi Kitamura³⁶, Yoshiyuki Matsui¹; Japanese Urological Oncology Group

Affiliations

¹ Department of Urology, National Cancer Center Hospital, Tokyo, Japan.
² Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, Japan.
³ Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan.
⁴ Department of Urology, The Jikei University School of Medicine, Japan.
⁵ Department of Urology and Andrology, Kansai Medical University, Osaka, Japan.
⁶ Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
⁷ Department of Urology, Hirosaki University Graduate School of Medicine, Aomori, Japan.
⁸ Department of Urology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
⁹ Department of Urology, Graduate School of Medicine, The University of Tokyo, Japan.
¹⁰ Department of Urology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
¹¹ Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan.
¹² Department of Urology, Jikei University Hospital, Tokyo, Japan.
¹³ Department of Urology, Akita University Graduate School of Medicine, Akita, Japan.
¹⁴ Department of Urology, Kurashiki Central Hospital, Okayama, Japan.
¹⁵ Department of Urology, Graduate School of Life Science, Kumamoto University, Kumamoto, Japan.
¹⁶ Department of Urology, Nara Medical University, Nara, Japan.
¹⁷ Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.
¹⁸ Department of Urology, Hamamatsu University School of Medicine, Shizuoka, Japan.
¹⁹ Department of Urology, Osaka International Cancer Institute, Osaka, Japan.
²⁰ Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
²¹ Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Mie, Japan.
²² Department of Urology, Harasanshin General Hospital, Fukuoka, Japan.
²³ Department of Urology, Tottori University Faculty of Medicine, Tottori, Japan.
²⁴ Department of Urology, Hyogo College of Medicine, Hyogo, Japan.
²⁵ Department of Urology, Jikei University Katsushika Medical Center, Tokyo, Japan.
²⁶ Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan.
²⁷ Department of Urology, Graduate School of Medicine, University of Ryukyus, Okinawa, Japan.
²⁸ Department of Urology, National Hospital Organization Shikoku Cancer Center, Ehime, Japan.
²⁹ Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
³⁰ Department of Urology, Kurume University School of Medicine, Fukuoka, Japan.
³¹ Department of Urology Graduate School of Medicine Yamaguchi University, Yamaguchi, Japan.
³² Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
³³ Department of Urology, Shimane University Faculty of Medicine, Shimane, Japan.
³⁴ Department of Urology, Aichi Cancer Center Hospital, Aichi, Japan.
³⁵ Department of Urology, Niigata University Graduate School of Medicine, Niigata, Japan.
³⁶ Department of Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama, Japan.

PMID: 38344879
DOI: 10.1111/bju.16296

Abstract

Objective: To analyse the impact of histological discordance of subtypes (subtypes or divergent differentiation [DD]) in specimens from transurethral resection (TUR) and radical cystectomy (RC) on the outcome of the patients with bladder cancer receiving RC.

Patients and methods: We analysed data for 2570 patients from a Japanese nationwide cohort with bladder cancer treated with RC between January 2013 and December 2019 at 36 institutions. The non-urinary tract recurrence-free survival (NUTR-FS) and overall survival (OS) stratified by TUR or RC specimen histology were determined. We also elucidated the predictive factors for OS in patients with subtype/DD bladder cancer.

Results: At median follow-up of 36.9 months, 835 (32.4%) patients had NUTR, and 691 (26.9%) died. No statistically significant disparities in OS or NUTR-FS were observed when TUR specimens were classified as pure-urothelial carcinoma (UC), subtypes, DD, or non-UC. Among 2449 patients diagnosed with pure-UC or subtype/DD in their TUR specimens, there was discordance between the pathological diagnosis in TUR and RC specimens. Histological subtypes in RC specimens had a significant prognostic impact. When we focused on 345 patients with subtype/DD in TUR specimens, a multivariate Cox regression analysis identified pre-RC neutrophil-lymphocyte ratio and pathological stage as independent prognostic factors for OS (P = 0.016 and P = 0.001, respectively). The presence of sarcomatoid subtype in TUR specimens and lymphovascular invasion in RC specimens had a marginal effect (P = 0.069 and P = 0.056, respectively).

Conclusion: This study demonstrated that the presence of subtype/DD in RC specimens but not in TUR specimens indicated a poor prognosis. In patients with subtype/DD in TUR specimens, pre-RC neutrophil-lymphocyte ratio and pathological stage were independent prognostic factors for OS.

Keywords: Bladder cancer; discordance; divergent differentiation; neutrophil-lymphocyte ratio; radical cystectomy; sarcomatoid; subtype; transurethral resection; urothelial carcinoma; variant histology.