具有变异组织学 (VH) 的膀胱癌 (BCa) 具有明显的侵袭性，并且不像纯尿路上皮癌 (UC) 那样得到充分研究。转移性疾病中 BCa 变异的特征可能有助于治疗反应/耐药性和随后的疾病进展。在本研究中，我们试图评估 VH 对转移性 BCa 中出现的转移部位的影响。查询了 2004 年至 2019 年国家癌症数据库，以分析患有 UC 和 VH BCa 的 cT1-4 cN0-3 cM1 患者。主要终点是是否存在不同器官的转移。进行二项式多变量逻辑回归以确定 VH 对转移部位的影响，同时控制多个变量。总共纳入了 6005 名诊断为 UC 或 VH 的符合条件的患者。具有小细胞组织学特征的患者（第二常见的 VH）更有可能发生肝转移（OR：4.335），而发生肺转移的可能性较小（OR：0.521）。鳞状细胞癌降低骨转移的几率（OR：0.449）。腺癌增加肺转移的几率（OR：1.690）。微乳头状 VH 转移至肺部的可能性较小（OR：0.182），但更有可能扩散至非区域淋巴结（OR：2.623）。肉瘤样亚型在任何转移部位的比值比上均未表现出统计学上显着的变化。本研究全面分析了有关转移性 BCa 和 VH 的有限研究。我们的分析强调了每种亚型都表现出异质转移向性。重要的是，这些发现说明了常规体细胞基因表达谱在指导适当分期和强化治疗方面的作用，并为 VH BCa 护理的未来研究奠定了基础。版权所有 © 2024 Elsevier Inc. 保留所有权利。

Bladder cancer (BCa) with variant histology (VH) is notably aggressive and not as well studied as pure urothelial carcinoma (UC). The characteristics of variant BCa in the setting of metastatic disease may contribute to treatment response/resistance and subsequent disease progression. In this study, we sought to assess VH's impact on metastasis sites at presentation in metastatic BCa.The National Cancer Database was queried from 2004 to 2019 to analyze cT1-4 cN0-3 cM1 patients with UC and VH BCa. The primary endpoint was the presence of metastasis to different organs. Binomial multivariable logistic regression was performed to determine the impact of VH on metastatic sites while controlling for multiple variables.Total 6005 eligible patients diagnosed with either UC or VH were included. Patients with small cell histology, the second most common VH, were more likely to have liver metastasis (OR: 4.335) while less likely to have lung metastases (OR: 0.521). Squamous cell carcinoma decreased the odds of bone metastasis (OR: 0.449). Adenocarcinoma increased the odds of lung metastases (OR: 1.690). Micropapillary VH is less likely to metastasize to the lungs (OR: 0.182) but more likely to spread to nonregional lymph nodes (OR: 2.623). Sarcomatoid subtype did not exhibit a statistically significant variation in the odds ratio for any of the metastatic sites.This study comprehensively analyzes the limited research regarding metastatic BCa and VH. Our analysis underscores each subtype exhibiting heterogeneous metastatic tropism. Importantly, these findings illustrate the role of routine somatic gene expression profiling to guide adequate staging and treatment intensification and to offer a foundation for future studies of VH BCa care.Copyright © 2024 Elsevier Inc. All rights reserved.