Navigating prognostic uncertainty in non-muscle invasive urothelial bladder cancer with focal squamous differentiation

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dc.contributor.authorShubhankar, Gen_US
dc.contributor.authorMittal, Aen_US
dc.contributor.authorPanwar, VKen_US
dc.contributor.authorTosh, JMen_US
dc.contributor.authorMandal, AKen_US
dc.date.accessioned2025-06-18T11:56:19Z
dc.date.available2025-06-18T11:56:19Z
dc.date.issued2025-04
dc.description.abstractObjectives: Transitional cell carcinoma (TCC), or urothelial carcinoma, represents the predominant histological type of bladder cancer. While the majority of TCC cases are characterized by conventional urothelial features, a significant subset exhibits variant histologies, such as focal squamous differentiation (SD). This variant is clinically noteworthy, given its association with more aggressive disease behavior and potential resistance to standard therapies, particularly intravesical Bacillus Calmette–Guérin (BCG) therapy. It raises critical challenges in prognosis and treatment. Materials and Methods: This single-center prospective cohort study enrolled patients with histopathologically confirmed TCC of the bladder, with or without focal SD, following transurethral resection of bladder tumor. Participants, devoid of deep muscle invasion and residual growth, received intravesical BCG therapy consisting of six weekly induction doses followed by 12 months of maintenance therapy. Outcomes were assessed through regular follow-up, utilizing clinical evaluations, imaging, urine cytology, and cystoscopy. The primary endpoints included recurrence-free survival (RFS), progression-free survival (PFS), and disease-specific survival (DSS). Results: Of the 131 patients evaluated, 35 exhibited focal SD. Statistically significant differences were observed between TCC with and without SD groups, with the former demonstrating poorer PFS (68.6% vs. 82.6%) and DSS (88.6% vs. 98%) after 1 year. However, RFS rates were comparable. Subgroup analysis revealed no significant differences in outcomes based on the extent of SD (>50% vs. <50%). Conclusion: Focal SD within TCC of the bladder portends a worse prognosis, particularly in terms of PFS and DSS, underscoring the necessity for tailored therapeutic approaches.en_US
dc.identifier.affiliationsDepartment of Urology, AIIMS, Rishikesh, Uttarakhand, Indiaen_US
dc.identifier.affiliationsDepartment of Urology, AIIMS, Rishikesh, Uttarakhand, Indiaen_US
dc.identifier.affiliationsDepartment of Urology, AIIMS, Rishikesh, Uttarakhand, Indiaen_US
dc.identifier.affiliationsDepartment of Urology, AIIMS, Rishikesh, Uttarakhand, Indiaen_US
dc.identifier.affiliationsDepartment of Urology, AIIMS, Rishikesh, Uttarakhand, Indiaen_US
dc.identifier.citationShubhankar G, Mittal A, Panwar VK, Tosh JM, Mandal AK. Navigating prognostic uncertainty in non-muscle invasive urothelial bladder cancer with focal squamous differentiation. Indian Journal of Medical Sciences. 2025 Apr; 77(1): 24-27en_US
dc.identifier.issn1998-3654
dc.identifier.issn0019-5359
dc.identifier.placeIndiaen_US
dc.identifier.urihttps://imsear.searo.who.int/handle/123456789/249719
dc.languageenen_US
dc.publisherScientific Scholaren_US
dc.relation.issuenumber1en_US
dc.relation.volume77en_US
dc.source.urihttps://dx.doi.org/10.25259/IJMS_277_2024en_US
dc.subjectBacillus Calmette–Guérin therapyen_US
dc.subjectFocal squamous differentiationen_US
dc.subjectIntravesical therapyen_US
dc.subjectNon-muscle invasive bladder canceren_US
dc.subjectVariant histologyen_US
dc.titleNavigating prognostic uncertainty in non-muscle invasive urothelial bladder cancer with focal squamous differentiationen_US
dc.typeJournal Articleen_US
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