OBJECTIVE To evaluate the concordance and prognostic role of histologic variants of bladder urothelial carcinoma
in transurethral resection of bladder tumor (TURBT) and radical cystectomy (RC) specimens.
METHODS Clinicopathologic information available at the time of RC and follow-up data from 4110 RC
specimens, collected between January 2000 and December 2009 at 17 tertiary referral centers
were retrospectively analyzed and evaluated for the presence or absence of uncommon variants of
bladder urothelial carcinoma. The presence or absence of uncommon variants of bladder urothelial
carcinoma was evaluated on previous TURBT specimens of patients undergoing RC. Cox
regression was used to assess the impact of these parameters on cancer-specific survival, and the
Kaplan-Meier test for disease-free survival was plotted for survival estimate.
RESULTS Of 4110 patients, 579 were found to have uncommon variants of bladder urothelial carcinoma at
RC (14.1%), whereas 266 (6.4%) at TURBT. A lack of agreement about uncommon variants was
observed between TURBT and RC specimens in the entire population (P <.001). The presence
of uncommon variants at TURBT was associated with an increased risk of pathologic upstage
(hazard ratio, 3.24; confidence interval, 1.19-6.37; P <.003) and significant decrease in cancerspecific
survival and recurrence-free survival (P <.001).
CONCLUSION Although the concordance of presence of uncommon histologic variants of urothelial
bladder carcinoma between TURBT and RC is low, the presence of uncommon histologic
variants of urothelial bladder carcinoma at TURBT is associated with a less favorable
