Squamous differentiation occurs in up to 20% of urothelial carcinoma cases and is thought
to be an unfavorable prognostic factor.
Methods
Data from urothelial carcinoma in patients treated with cystectomy from 2002 to 2014 at
Roswell Park Cancer Institute were retrospectively reviewed. A 2-tier system was adopted for
stage analysis. T1 and T2 disease were grouped in organ-confined and low-stage categories,
whereas T3 and T4 disease were grouped in high-stage categories. The extent of squamous
differentiation was semi-quantified as focal (≤ 20%) or extensive (> 20%).
Results
Squamous differentiation occurred in 19.3% (47 of 244) of cases. Urothelial carcinoma with
squamous differentiation presented with a significantly higher rate of high-stage disease
compared with pure urothelial carcinoma (72.3% vs 43.1%; P < .01). The nodal metastatic
rate in urothelial carcinoma with extensive squamous differentiation was significantly
higher than that seen in pure urothelial carcinoma (46.2% vs 27.0%; P = .04).
Conclusions
Urothelial carcinoma with squamous differentiation is associated with advanced tumor stage.
In addition, urothelial carcinoma with extensive squamous differentiation presented with a
significantly higher rate of nodal metastasis. These findings can be the contributing
factors for the unfavorable clinical outcomes seen in patients with urothelial carcinoma and
squamous differentiation.
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