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Squamous carcinoma of the bladder has a poor prognosis. Low overall 5 year survival 7-50% is cited due to advanced stage at presentation, grade and vascular density. We show in our series that there are many unusual features of this tumour. This includes a worse all cause mortality that, we propose, is probably due to worse co-morbidities than in the TCC population.
Study population was 258 patients who underwent radical cystectomy who were followed over 18 years. 230 had transitional cell cancer and 16 had squamous cell cancer on final histology. Kaplan Meier curves are generated. Patient and tumour characteristics are compared.
16 Squamous cell
230 Transition cell
P value Fishers and t
Tumour volume cc
Positive surgical margins
Node positive patients
Number of nodes positive (total number of nodes)
Proportion of ECE
2/13 = 0.15
22/128 = 0.17
83/185 = 0.45
Progression free survival at 5 years
Disease specific survival at 5 years
All cause survival at 5 years
Number of disease specific deaths
Number of all cause deaths
SCC is quoted as accounting for only 1% of bladder cancer in UK. Our series has 6%. We note a number of differences between the two categories of SCC and TCC. Our series showed a predominance of women 69% with SCC which is contrary to most bladder cancer series with of 19% TCC being women. Both cohorts are of a similar age. The grade of squamous cell tumours are significantly lower than TCC yet have a far worse prognosis. 50% were low (2) or intermediate (6) grade SCC compared to only 7% with TCC. This may be partly related to the far larger tumour volume. Overall mean tumour volume of 106cc for SCC and 14cc for TCC. There was no significant difference between tumour volume of high grade SCC (101cc) compared to medium and low grade SCC (111cc). Only 19% of SCC were localised compared to 61% for TCC. 81% of SCC were locally advanced. 38% of SCC had positive surgical margins compared to only 9% of TCC. Interestingly, we do not see any greater lymph node involvement. We see an earlier tendency to progression ( 40% at 5 years local recurrence or metastasis) for SCC compared to only 24% for TCC. There is a higher disease specific mortality of 50% for SCC compared to only 29% for TCC at 5 years. However there is a far higher all cause mortality of 81% at 5 years with SCC compared to 39% for TCC.
The study population have very large tumours that are locally advanced with positive surgical margins. The tumour volumes are of a similar size amongst the range of grades in SCC. There is a greater disease specific mortality for SCC. However, half of SCC are low and intermediate grades. Both long term SCC survivors had high grade tumours. A high grade SCC may not be as severe as a high grade TCC? Low and medium grade SCC does not confer a survival advantage, the effect of stage being a more powerful determinant of prognosis. There is a worse prognosis for SCC. This is probably due to a higher incidence of severe comorbidities accounting for the worse all cause mortality. Features specific to SCC account for the higher disease specific mortality.