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Open Access Research article

Plasmacytoid variant of bladder cancer defines patients with poor prognosis if treated with cystectomy and adjuvant cisplatin-based chemotherapy

Bastian Keck1*, Sven Wach1, Robert Stoehr2, Frank Kunath1, Simone Bertz2, Jan Lehmann3, Michael Stöckle4, Helge Taubert1, Bernd Wullich1 and Arndt Hartmann2

Author affiliations

1 Department of Urology, University Erlangen, Krankenhausstraße 12, Erlangen, 91054, Germany

2 Department of Pathology, University Erlangen, Krankenhausstr 8-10, Erlangen, 91054, Germany

3 Urology Practice, Prüner Gang, Prüner Gang 15, Kiel, 24103, Germany

4 Department of Urology, Saarland University, Kirrberger Straße, Homburg/Saar, 66421, Germany

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Citation and License

BMC Cancer 2013, 13:71  doi:10.1186/1471-2407-13-71

Published: 8 February 2013

Abstract

Background

Since the definition of different histologic subtypes of urothelial carcinomas by the World Health Organization (WHO) 2004 classification, description of molecular features and clinical behavior of these variants has gained more attention.

Methods

We reviewed 205 tumor samples of patients with locally advanced bladder cancer mainly treated within the randomized AUO-AB05/95 trial with radical cystectomy and adjuvant cisplatin-based chemotherapy for histologic subtypes. 178 UC, 18 plasmacytoid (PUC) and 9 micropapillary (MPC) carcinomas of the bladder were identified. Kaplan Meier analysis and backward multivariate Cox’s proportional hazards regression analysis were performed to compare overall survival between the three histologic subtypes.

Results

Patients suffering from PUC have the worst clinical outcome regarding overall survival compared to conventional UC and MPC of the bladder that in turn seem have to best clinical outcome (27.4 months, 62.6 months, and 64.2 months, respectively; p=0.013 by Kaplan Meier analysis). Backward multivariate Cox´s proportional hazards regression analysis (adjusted to relevant clinicopathological parameters) showed a hazard ratio of 3.2 (p=0.045) for PUC in contrast to patients suffering from MPC.

Conclusions

Histopathological diagnosis of rare variants of urothelial carcinoma can identify patients with poor prognosis.

Keywords:
Chemotherapy; Cystectomy; Micropapillary; Plasmacytoid; Prognosis; Urinary bladder neoplasm