Outcomes Following Radical Cystectomy For Nested Variant of Urothelial Carcinoma: A Matched Cohort Analysis
Linder BJ, Frank I, Cheville JC, Thompson RH, Thapa P, Tarrell RF, Boorjian SA. J Urol. 2012 Nov 6. pii: S0022-5347(12)05471-7. doi: 10.1016/j.juro.2012.11.006. [Epub ahead of print]


Department of Urology, Mayo Clinic, Rochester, MN.



To evaluate the oncologic outcomes following radical cystectomy for patients with nested variant (NV) of urothelial carcinoma (UC), and compare survival to patients with pure UC of the bladder.


We identified 52 patients with NV treated with radical cystectomy between 1980-2004. Pathologic specimens were re-reviewed by a single genitourinary pathologist. These patients were matched in a 1:2 fashion by age, gender, ECOG performance status, pathologic tumor stage, and nodal status to patients with pure UC. Survival was estimated using the Kaplan Meier method and compared with the log-rank test.


Patients with NV had a median age of 69.5 years (IQR 62, 74) and a median post-operative follow-up of 10.8 years (IQR 9.3, 11.2). NV cancers were associated with a high rate of adverse pathologic features as 36 (69%) had pT3-T4 disease, and 10 (19%) had nodal invasion. A total of 8 (15%) patients with NV cancer received peri-operative chemotherapy. When patients with NV were then matched to a cohort of patients with pure UC, no significant differences were noted with regard to 10-year local recurrence-free survival (83% versus 80%; p= 0.46) or 10-year cancer-specific survival (41% versus 46%; p=0.75).


NV of UC is associated with a high rate of locally-advanced disease at RC. However, when stage-matched to patients with pure UC, patients with NV did not have increased rates of recurrence or adverse survival. Further studies will be required to validate these findings and guide the optimal multimodal management approach to these patients.