Objectives: Variant urothelial carcinoma (VUC) represents a diverse group of bladder cancer subtypes with distinct clinical behaviors and prognostic implications. This study aims to evaluate survival outcomes and prognostic factors in patients diagnosed with VUC.

Materials and Methods: A retrospective analysis was conducted on 1844 bladder cancer patients treated at our center between 2018 and 2022. Among them, 59 patients with histologically confirmed VUC were included. Survival outcomes were assessed using Kaplan– Meier analysis, and prognostic factors were evaluated via multivariable Cox regression models.

Results: The most common VUC subtypes were squamous (39%), micropapillary (23.7%), and sarcomatoid (6.8%). The median overall survival (OS) was 11 months, while cancer-specific survival (CSS) was 7 months. Micropapillary and sarcomatoid variants exhibited significantly poorer CSS, with an approximately 8-fold and 7-fold increased mortality risk compared to squamous subtype, respectively. Age and the presence of metastases were key predictors of worse CSS. While radical cystectomy was performed in 30.5% of patients, it did not significantly improve survival.

Conclusion: Our findings underscore the aggressive nature of micropapillary and sarcomatoid VUC subtypes, highlighting the need for individualized treatment approaches. Age and metastatic status were significant determinants of survival, emphasizing the necessity for early diagnosis and targeted therapeutic strategies. Future research should explore molecular profiling and novel treatment modalities, including immunotherapies, to improve patient outcomes.

Keywords : variant urothelial carcinoma, bladder cancer, survival, prognosis, histological variants