BACKGROUND We retrospectively evaluated the clinical outcomes of patients with histologic variants of muscle invasive bladder cancer (MIBC) treated with trimodal bladder-preserving therapy (TMT). METHODS Among 148 patients with clinical T2-3N0M0 MIBC treated with TMT at Tsukuba University Hospital from 1990 to 2015, 11 patients (7.4%) had pathological components of variant urothelial carcinoma (UC). The complete response (CR), overall survival (OS), cause-specific survival (CSS) and progression-free survival (PFS) rates were analyzed in these 11 patients. RESULTS Among the 11 patients with variant UC, 7 (64%) had UC with squamous and/or glandular differentiation and 4 (36%) had sarcomatoid (n = 1), plasmacytoid (n = 1), signet ring cell (n = 1), or clear cell variant (n = 1). Median follow-up was 49.0 months. Nine (82%) out of 11 patients achieved CR and 2 (22%) out of the 9 developed recurrence. Among seven patients who had UC with squamous and/or glandular differentiation, two developed recurrence and one died of disease. In contrast, 2 (50%) out of four patients with other variants, which were sarcomatoid variant or signet ring cell, developed recurrence and died of disease. Overall, the 5-year OS, CSS, and PFS rates of variant UC were 75%, 75%, and 58%, respectively. CONCLUSIONS TMT might provide acceptable clinical outcomes for well-selected MIBC patients with histologic variants, especially for those with squamous and/or glandular differentiation. However, we need to pay special attention to other variants such as sarcomatoid variant or signet ring cell. TMT might be an alternative treatment option for patients with histologic variants, although further experiments will be needed to confirm this.

中文翻译：

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尿路上皮癌组织学变异的三峰保留膀胱疗法的单一机构经验。

背景：我们回顾性评估了采用三峰保留膀胱疗法（TMT）治疗的组织浸润性肌肉浸润性膀胱癌（MIBC）的患者的临床结局。方法1990年至2015年，筑波大学医院（Tsukuba University Hospital）的148例接受TMT治疗的T2-3N0M0型MIBC临床患者中，有11例（7.4％）患有变型尿路上皮癌（UC）的病理成分。分析了这11例患者的完全缓解率（CR），总生存期（OS），特定原因生存期（CSS）和无进展生存期（PFS）率。结果在11例UC变异患者中，有7例（64％）患有鳞状和/或腺体分化的UC，4例（36％）患有肉瘤（n = 1），浆细胞样（n = 1），印戒细胞（n = 1）或透明单元格变体（n = 1）。中位随访时间为49.0个月。11例患者中有9例（82％）达到了CR，9例复发者中有2例（22％）实现了CR。在患有鳞状和/或腺样分化的UC的七名患者中，有两名复发，有一名死于疾病。相比之下，四名患有肉瘤样变体或印戒细胞的其他变体患者中有2（50％）复发并死于疾病。总体而言，变异UC的5年OS，CSS和PFS率分别为75％，75％和58％。结论TMT可以为精心挑选的具有组织学变异的MIBC患者提供可接受的临床结果，尤其是对于鳞状和/或腺体分化的患者。但是，我们需要特别注意其他变异，例如肉瘤样变异或印戒细胞。对于组织学变异患者，TMT可能是另一种治疗选择，