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Chou LP, Hsu CW, Yang SF, Lee CT, Ou YC, Lin KC, Hu CY, Jou YC, Tsai YS, Chow NH. Clinicopathologic Analysis of Micropapillary Urothelial Carcinoma of the Upper Urinary Tract: Implications for HER2-Targeted Therapy. Clin Genitourin Cancer 2023; 21:508.e1-508.e10. [PMID: 37183125 DOI: 10.1016/j.clgc.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 04/10/2023] [Accepted: 04/10/2023] [Indexed: 05/16/2023]
Abstract
Introduction/Background To determine the clinical significance of micropapillary urothelial carcinoma (MPUC) of the upper urinary tract (UTUC) and a potential therapeutic strategy. Patients and Methods A retrospective cohort study was conducted to examine the incidence of micropapillary UTUC from 2010 to 2018 and its clinicopathological characteristics. Clinical outcomes and cancer-specific survival (CSS) were compared between MPUC and conventional UTUC matched by stage within a 6-month variation of receiving surgery. Results A total of 24 MPUC cases were identified out of 901 cases (2.7%) of urothelial carcinoma (UC) of the renal pelvis and ureter. MPUC was significantly smaller (<3 cm) and associated with nodal metastasis compared with conventional UTUC (P = .017 & 0.021, respectively); however, no significant difference was observed for lymphovascular invasion, distant metastasis, or CSS (P > 0.50, respectively) compared with match controls. Six MPUC patients (25%) developed metastasis to the liver, lymph nodes, and lung during follow-up. Patients with HER2-positive MPUC (3 of 4) had a significantly higher risk of metastasis compared with HER2-negative MPUC (3 of 20; P = 0.035). Conclusions MPUC is an aggressive variant of UTUC and usually presents as a small locally advanced disease. HER2 immunohistochemistry may identify the subset of patients with micropapillary UTUC that are candidates for targeted therapy.
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Affiliation(s)
- Lien-Ping Chou
- Department of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan
| | - Che-Wei Hsu
- Department of Pathology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Sheau-Fang Yang
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Pathology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Ta Lee
- Department of Pathology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yin-Chien Ou
- Department of Urology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kun-Che Lin
- Department of Urology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Che-Yuan Hu
- Department of Urology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yeong-Chin Jou
- Division of Urology, Department of Surgery, St Martin De Porres Hospital, Chia-Yi City, Taiwan.
| | - Yuh-Shyan Tsai
- Department of Urology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Nan-Haw Chow
- Department of Pathology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Diamantopoulos LN, Holt SK, Khaki AR, Sekar RR, Gadzinski A, Nyame YA, Vakar-Lopez F, Tretiakova MS, Psutka SP, Gore JL, Lin DW, Schade GR, Hsieh AC, Lee JK, Yezefski T, Schweizer MT, Cheng HH, Yu EY, True LD, Montgomery RB, Grivas P, Wright JL. Response to Neoadjuvant Chemotherapy and Survival in Micropapillary Urothelial Carcinoma: Data From a Tertiary Referral Center and the Surveillance, Epidemiology, and End Results (SEER) Program. Clin Genitourin Cancer 2020; 19:144-154. [PMID: 33160889 DOI: 10.1016/j.clgc.2020.10.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 10/01/2020] [Accepted: 10/04/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Micropapillary urothelial carcinoma (MPC) is a rare urothelial carcinoma variant with conflicting data guiding clinical practice. In this study, we explored oncologic outcomes in relation to neoadjuvant chemotherapy (NAC) in a retrospective cohort of patients with MPC, alongside data from Surveillance, Epidemiology, and End Results (SEER)-Medicare. PATIENTS AND METHODS We retrospectively identified patients with MPC or conventional urothelial carcinoma (CUC) without any variant histology undergoing radical cystectomy (RC) in our institution (2003-2018). SEER-Medicare was also queried to identify patients diagnosed with MPC (2004-2015). Clinicopathologic data and treatment modalities were extracted. Overall survival (OS) was estimated with the Kaplan-Meier method. Mann-Whitney-Wilcoxon and chi-square tests were used for comparative analysis and Cox regression for identifying clinical covariates associated with OS. RESULTS Our institutional database yielded 46 patients with MPC and 457 with CUC. In SEER-Medicare, 183 patients with MPC were identified, and 63 (34%) underwent RC. In the institutional cohort, patients with MPC had significantly higher incidence of cN+ (17% vs. 8%), pN+ stage (30% vs. 17%), carcinoma-in-situ (43% vs. 25%), and lymphovascular invasion (30% vs. 16%) at RC versus those with CUC (all P < .05). Pathologic complete response (ypT0N0) to NAC was 33% for MPC and 35% for CUC (P = .899). Median OS was lower for institutional MPC versus CUC in univariate analysis (43.6 vs. 105.3 months, P = .006); however, MPC was not independently associated with OS in the multivariate model. Median OS was 25 months in the SEER MPC cohort for patients undergoing RC, while NAC was not associated with improved OS in that group. CONCLUSION Pathologic response to NAC was not significantly different between MPC and CUC, while MPC histology was not an independent predictor of OS. Further studies are needed to better understand biological mechanisms behind its aggressive features as well as the role of NAC in this histology variant.
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Affiliation(s)
- Leonidas N Diamantopoulos
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA
| | - Sarah K Holt
- Department of Urology, University of Washington, Seattle, WA
| | - Ali R Khaki
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA
| | - Rishi R Sekar
- Department of Urology, University of Washington, Seattle, WA
| | - Adam Gadzinski
- Department of Urology, University of Washington, Seattle, WA
| | - Yaw A Nyame
- Department of Urology, University of Washington, Seattle, WA
| | | | | | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle, WA
| | - John L Gore
- Department of Urology, University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Daniel W Lin
- Department of Urology, University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - George R Schade
- Department of Urology, University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Andrew C Hsieh
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - John K Lee
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Todd Yezefski
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA
| | - Michael T Schweizer
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Heather H Cheng
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Evan Y Yu
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Lawrence D True
- Department of Pathology, University of Washington, Seattle, WA
| | - Robert B Montgomery
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Petros Grivas
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA.
| | - Jonathan L Wright
- Department of Urology, University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA.
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Alderson M, Grivas P, Milowsky MI, Wobker SE. Histologic Variants of Urothelial Carcinoma: Morphology, Molecular Features and Clinical Implications. Bladder Cancer 2020. [DOI: 10.3233/blc-190257] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Bladder cancer is a heterogeneous disease including conventional urothelial carcinoma (UC) and its histologic variants, and non-urothelial carcinoma, including squamous and glandular neoplasms. Urothelial carcinoma accounts for the majority of bladder cancer cases, but morphologic variants are common and include nested, microcystic, micropapillary, lymphoepithelioma-like, plasmacytoid, sarcomatoid, giant cell, undifferentiated, clear cell and lipoid. Certain variants of UC tend to be associated with a poor prognosis and have diagnostic and potential treatment implications that make the identification of variant histology crucial to clinical decision making. While there is still uncertainty regarding the prognostic implications of many of these variants, identifying and reporting variant histology is important to develop our understanding of their biology. Unique molecular features accompany many of these morphologic variants and to better understand these tumors, we review the molecular and clinical implications of histologic variants of bladder cancer. Major efforts are underway to include variant histology and divergent differentiation of UC in clinical trials to develop evidence based approaches to treatment. The purpose of this article is to review the current literature on variant histology of urothelial cancer and to highlight molecular findings and the clinical relevance of these tumors.
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Affiliation(s)
- Meera Alderson
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Petros Grivas
- University of Washington School of Medicine, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Matthew I. Milowsky
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Sara E. Wobker
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
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