Ashish M. Kamat, President of IBCG, Associated Editor at European Urology Oncology, shared a post on X:
“Pleased to share an outstanding collaborative review by Roger Li, Laura Bukavina, Can Aydogdu and European Urology.
Each histological subtype of bladder cancer behaves differently and deserves its own approach, not a one-size-fits-all approach.
Here we synthesize the latest data on this topic.
Subtype histology is consistently understaged on TURBT – eg micropapillary: occult N+ in up to 38% of cases at upfront cystectomy; sarcomatoid and squamous: T3+ in over two-thirds of cases.
This is why early radical cystectomy should be discussed even for clinically non-muscle-invasive disease with these histologies. The 2026 EAU Guidelines now reflect that.
Neoadjuvant chemotherapy does not perform uniformly across subtypes.
Small cell carcinoma is the clear exception, platinum-etoposide regimens improve OS dramatically. Squamous and plasmacytoid show poor pCR rates and no consistent survival benefit.
Pathologic response should be interpreted with real caution here. Same lesson we keep learning about pCR more broadly.
The genomics point toward where targeted therapy is heading.
Micropapillary, ERBB2/FGFR3 alterations. Sarcomatoid and squamous, high PD-L1, immune checkpoint activity. Plasmacytoid, high Nectin-4 despite chemoresistance. Small cell, DLL3 as an emerging target.”
Title: Histological Subtypes and Divergent Differentiation of Urothelial Carcinoma: Histology, Genomics, and Management Implications
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Authors: Can Aydogdu, Laura Bukavina, Liang Cheng, Hikmat A. Al-Ahmadie, Omar Alhalabi, Jason R. Brown, Antonio Lopez-Beltran, Petros Grivas, Clara Hwang, G. Daniel Grass, Ashish M. Kamat, Jonathan Chatzkel, Omar Mian, Andrea Necchi, Jeff Ross, Andrea B. Apolo, Philippe E. Spiess, Roger Li.
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