Clinicopathological features and prognosis of plasmacytoid urothelial carcinoma of the bladder: A retrospective analysis of 36 cases.

Authors

Xueping Liu, Kui Fu, Lixia Xiong, Xuewu Liu, Junqiang Liang

Published in

Urologic oncology. Jul 14, 2026. Epub Jul 14, 2026.

Abstract

To investigate the clinicopathological features, immunophenotype, treatment response, and prognosis of plasmacytoid urothelial carcinoma (PUC) of the bladder, and to provide evidence for clinical management.
We retrospectively reviewed 36 patients with PUC treated at our institution from January 2014 to June 2024. Seventy-eight patients with conventional high-grade urothelial carcinoma (UC) treated during the same period served as a contemporaneous comparison cohort. The UC cohort was not matched to the PUC cohort. Clinicopathological characteristics, immunohistochemical expression, treatment modalities, and outcomes were compared between groups. Because treatment strategies were heterogeneous, pathological and recurrence analyses were restricted to patients undergoing radical cystectomy, and neoadjuvant chemotherapy response analyses were restricted to patients receiving neoadjuvant chemotherapy followed by radical surgery. Survival was analyzed using the Kaplan-Meier method and Cox regression.
The PUC group comprised 31 males (86.11%) and 5 females (13.89%) with a median age of 66 years; the UC group comprised 65 males (83.33%) and 13 females (16.67%) with a median age of 63 years. No significant differences were observed in sex or age between groups (P > 0.05). Among patients undergoing radical cystectomy, the PUC group demonstrated significantly higher rates of pT3/4 stage (66.67% vs. 29.51%), pathological upstaging from clinical stage to final pathological stage after radical cystectomy (45.83% vs. 21.31%), lymph node positivity (37.50% vs. 16.39%), lymphovascular invasion (58.33% vs. 34.43%), and positive surgical margins (20.83% vs. 4.92%) compared with the UC group (all P < 0.05). Immunohistochemistry revealed significantly higher rates of CD138 positivity (91.67%), E-cadherin loss (69.44%), HER2 overexpression (3+) (33.33%), and a higher Ki-67 index in the PUC group (all P < 0.01). The pathological complete response rate after neoadjuvant chemotherapy was 12.50% in the PUC group vs. 32.14% in the UC group (P = 0.168). With a median follow-up of 26 months, the median overall survival was 25 months in the PUC group, significantly shorter than in the UC group (not reached) (P < 0.01). Among patients undergoing radical cystectomy, the peritoneal metastasis rate was significantly higher in the PUC group (20.83% vs. 3.28%, P < 0.05).
PUC was associated with more advanced disease, adverse pathological features, and worse survival than conventional high-grade UC in this retrospective single-center cohort. CD138 positivity and E-cadherin loss were characteristic immunohistochemical findings, while peritoneal dissemination appeared to represent a distinctive metastatic pattern. The lower pathological complete response rate observed after neoadjuvant chemotherapy and the higher frequency of HER2 overexpression should be interpreted cautiously because of the limited sample size, treatment heterogeneity, and retrospective design.

PMID:
42448545
Bibliographic data and abstract were imported from PubMed on 15 Jul 2026.

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