Words of wisdom. Re: the role of squamous differentiation in patients with transitional cell carcinoma of the bladder treated with radical cystectomy.

of lymph node metastases, which may have affected results. Certainly these results have not been demonstrated by other investigators that have found no statistically significant difference between squamous differentiation and pure TCC, although many have shown mortality reductions with other subtypes such as adenocarinoma, carcinosarcoma and small cell carcinoma of the bladder (1-3). Nonetheless, it remains crucial that further, preferably randomized or well conducted retrospective studies are performed, to confirm which TCC subtypes truly portend a poorer prognosis. This data could then be used to assist in the integration of chemotherapy or radiotherapy, together with surgery in the management of these aggressive cancers in order to improve clinical outcomes. References 1. Richie JP, Waisman J, Skinner DG, Dretler SP: Squamous carcinoma of the bladder: treatment by radical cystectomy. J Urol. 1976; 115: 670-2. 2. Ghoneim MA, el-Mekresh MM, el-Baz MA, el-Attar IA, Ashamallah A: Radical cystectomy for carcinoma of the bladder ; critical evaluation of results in 1026 cases J Urol. 1997; 158: 393-9. 3. Rogers CG, Palapattu GS, Shariat SF, Karakiewic PI, Bastian PJ, Lotan Y, et al.: Clinical outcomes following radical cystectomy for primary non transitional cell carcinoma of the bladder compared to transitional cell carcinoma of the bladder J Urol. 2006; 175: 2048-53.