Clinicopathologic and Survival After Cystectomy Outcomes in Squamous Cell Carcinoma of the Bladder

Clin Genitourin Cancer. 2023 Dec;21(6):631-638.e1. doi: 10.1016/j.clgc.2023.05.019. Epub 2023 May 30.


Background: Squamous cell carcinoma of the bladder (SqCC) is a rare disease with limited management data. Thus, we sought to characterize the clinicopathologic and survival outcomes amongst patients with SqCC and explore the association of squamous differentiation within urothelial carcinoma (UC w/Squam), as compared to muscle invasive pure UC.

Methods: We conducted a single-center retrospective cohort study of patients, stratified by histology, who underwent cystectomy for MIBC. Baseline clinicopathologic characteristics were compared, and overall survival was assessed using Kaplan-Meier method.

Results: We identified 1,034 patients; 37 (3.58%) with SqCC histology, 908 (87.81%) with UC histology, and 89 (8.61%) with UC w/ Squam histology. Among SqCC patients, a higher proportion were Black and similarly a higher proportion were women; amongst patients with UC w/ Squam a higher proportion had lower BMI; and amongst patients with UC a higher proportion had lower clinical (c) T, cN, pathological (p) T, and pN stages. Patients presenting with UC were more likely to receive intravesical therapy; patients presenting with SqCC were less likely to receive neoadjuvant chemotherapy (NAC). Adjuvant chemotherapy rates were similar. With post-hoc Bonferroni analysis, overall survival, cancer-specific survival, and recurrence-free survival were significantly worse for the UC w/ Squam cohort.

Conclusions: UC w/ Squam histology was associated with worse survival outcomes after cystectomy for muscle invasive bladder cancer compared to UC. Our results suggest that UC w/ Squam is associated with more advanced disease compared to UC, warranting further prospective work on consideration of combination therapies for patients with this disease state.

Keywords: Cystectomy; Neoadjuvant chemotherapy; Urothelial carcinoma; Variant histology.

MeSH terms

  • Carcinoma, Squamous Cell* / surgery
  • Carcinoma, Transitional Cell* / pathology
  • Cystectomy / methods
  • Female
  • Humans
  • Male
  • Neoadjuvant Therapy
  • Retrospective Studies
  • Urinary Bladder / pathology
  • Urinary Bladder Neoplasms* / pathology