Objective:

To evaluate the prognostic impact of squamous differentiation in bladder cancer by comparing clinicopathological characteristics and survival outcomes among patients with pure urothelial carcinoma (UC), urothelial carcinoma with squamous differentiation (UCSD), and pure squamous cell carcinoma (SCC) treated with radical cystectomy (RC).

Approach:

• Study Design: A single-center, retrospective cohort analysis was conducted, identifying patients who underwent RC for bladder cancer from January 2015 to June 2024.
• Patient Stratification: Patients were stratified into three groups based on final pathology: pure UC, UCSD, and SCC.
• Statistical Analysis: Overall survival (OS) was analyzed using Kaplan-Meier methods and multivariable Cox regression, with 1:1 propensity score matching to control for baseline imbalances.

Key Findings:

• Patients with UCSD and SCC presented with more advanced disease and had significantly worse 5-year OS (42.1% and 38.9%, respectively) compared to the pure UC group (62.5%).
• After 1:1 propensity score matching, 5-year OS rates were 59.5% for pure UC, 45.8% for UCSD, and 42.6% for SCC.
• Squamous differentiation was an independent predictor of worse OS, with UCSD and SCC associated with significantly poorer prognosis compared to pure UC.

Interpretation:

Limitations:

• The study is retrospective and conducted at a single center, which may limit generalizability.
• The sample size for SCC was relatively small, potentially affecting the robustness of comparisons.

Conclusion: