What Is the Prognostic and Clinical Importance of Urothelial and Nonurothelial Histological Variants of Bladder Cancer in Predicting Oncological Outcomes in Patients with Muscle-invasive and Metastatic Bladder Cancer? A European Association of Urology Muscle Invasive and Metastatic Bladder Cancer Guidelines Panel Systematic Review (European Urology Oncology)

Selection of treatment for bladder cancer should include assessment of histological findings as treatment outcomes will vary depending on the histological variant identified. Based on this systematic review, with the caveat that not all treatment modalities currently offered to patients with muscle-invasive bladder cancer (MIBC) could be assessed due to lack of data (eg, for bladder-preserving techniques), radical cystectomy should be offered to all patients diagnosed with MIBC. Neoadjuvant chemotherapy may be beneficial for patients with micropapillary, plasmacytoid, sarcomatoid, and mixed variants, and neuroendocrine features. Improved bladder tumour resection techniques, and advanced tissue sampling and reporting will add more evidence about the role of histological variants.