越来越多的证据表明，采用化疗放射联合治疗保留膀胱可以达到与根治性膀胱切除（5年生存率50% - 70%）相当的生存率，对于患有肌层侵犯性膀胱移行细胞癌（UC）的患者来说，其生活质量也更好。然而，多达55％的患者患有变异组织学，并且在本次回顾中，我们旨在澄清对于这一组患者膀胱保留治疗的作用。我们首先区分了具有分化差异的膀胱移行细胞癌（UCDD）和非膀胱移行细胞癌（NUC）。UCDD很常见，发病率也在增加，尽管每个亚型可能有其自身的特点，但目前的证据表明经根治性膀胱切除和膀胱保留治疗达到的效果相当。非膀胱移行细胞癌是一组不同病理类型的集合，每种类型都应有其自身的管理策略。然而，这些肿瘤很少见，证据来源于具有显著固有偏见的回顾性研究。膀胱的小细胞癌有较好的保留治疗证据；然而，其他病理类型，如鳞状细胞癌和腺癌，得到的支持不足。我们建议对每种亚型的证据进行仔细的多学科评估，并在做出治疗决策之前，与患者进行诚实的讨论，说明证据的有限性。随着我们探索未来的分子分析技术，可能有助于更好地表征这些肿瘤，并有助于治疗选择。版权所有©2022 Elsevier Inc.发布。

A growing body of evidence has shown bladder-preservation with chemo-radiotherapy achieves comparable survival to Radical Cystectomy (5-year OS 50%-70%) and superior quality of life outcomes for patients with muscle-invasive urothelial carcinoma of the bladder (UC). However, up to 55% of patients harbor variant histology and in this review we aim to clarify the role of bladder-preservation for this group. We first draw the distinction between urothelial carcinoma with divergent differentiation (UCDD) and non-urothelial carcinoma (NUC). UCDD is common, increasing in prevalence, and whilst each subtype may have its own characteristics current evidence suggests comparable outcomes with radical cystectomy and bladder-preservation. Non-urothelial carcinoma is a collection of distinct pathologies each deserving of its own management strategy. However, these tumors are rare, and evidence is generated from retrospective studies with significant inherent bias. Small cell carcinoma of the bladder has good evidence for bladder-preservation; however, other pathologies such as Squamous Cell Carcinoma and Adenocarcinoma are not well supported. We recommend careful multidisciplinary appraisal of the evidence for each subtype and honest patient discussion about the limited evidence before reaching management decisions. As we look to the future molecular-profiling may help better characterize these tumors and aid in treatment selection.Copyright © 2022. Published by Elsevier Inc.