Sarcomatoid Urothelial Carcinoma of the Urinary Bladder: A Clinicopathologic Study of 31 Cases
Joseph M Sanfrancesco, Donna Hansel. Cleveland Clinic Foundation, Cleveland, OH
Background: Urothelial carcinoma (UCa) represents the most common type of bladder cancer (>90%), with multiple histological variants of UCa reported. One of the more aggressive types is the sarcomatoid variant; however, studies on outcomes are limited by the number of published articles that address this rare variant. We reviewed one of the larger cohorts of sarcomatoid UCa and present clinicopathological findings associated with this entity.
Design: Using a laboratory database search, 31 cases of sarcomatoid UCa were compiled from 2000 to present, including biopsies (n=3), transuretheral resection (TUR) specimens (n=3), and radical cystectomy and cystoprostatectomy specimens (n=25). All cases were re-reviewed for histopathological parameters, including diagnosis, margin status, tumor stage, presence/absence of lymph node metastases, and concurrent in situ disease. Patient follow-up was obtained, with included disease course, treatment modalities, and survival data.
Results: Of the 31 cases reviewed, nineteen patients were men and twelve were women (M:F ratio = 1.6:1); ages ranged from 45 to 92 (mean 70.3; median 71.5). All patients (n=31) had biopsy/TUR proven invasive UCa, with 58.1% (18/31) with sarcomatoid features at initial diagnosis. All patients who received only biopsy/TUR (n=6) had invasive UCa with sarcomatoid features and 50% (3/6) had metastases at diagnosis. None of these patients had previously been treated with Bacillus Calmette–Guérin (BCG) and 67% (4/6) of these patients received post-procedural chemotherapy and/or palliative radiation. Of the patients who underwent cystectomy or cystoprostatectomy (n=25), 36% (9/25) had lymph node metastases at resection, 16% (4/25) had a positive soft tissue margin, and 8% (2/25) had a margin involved by in situ disease. 64% (16/25) of patients received post-operative/procedural chemotherapy and one patient (4%) received combination chemo-and radiotherapy. At the time of this study, twenty-one patients were deceased (87.5%). Overall mean survival for the deceased patients was 9.1 months with four patients expiring secondary to surgical complications and medical co-morbidities. Seven patients were lost to follow-up.
Conclusions: Sarcomatoid UCa represents an aggressive form of UCa, with the majority of patients dying of disease within one year of diagnosis. Further evaluation of molecular targets in this disease entity may be of value to identify potential new therapeutic options to enhance survival.
Category: Genitourinary (including renal tumors)
Wednesday, March 6, 2013 1:00 PM
Poster Session VI # 169, Wednesday Afternoon