Shariat S F, Weizer A Z, Green A, Laucirica R, Frolov A, Wheeler T M, Lerner S P
Scott Department of Urology, Baylor College of Medicine and Methodist Hospital, Houston, Texas, USA.
Urology. 2000 Nov 1;56(5):735-40. doi: 10.1016/s0090-4295(00)00756-1.
To determine whether molecular and histopathologic tumor features can predict disease progression in Stage T1 transitional cell carcinoma of the bladder.
Tumor specimens from 43 patients were analyzed with respect to grade, presence of carcinoma in situ, invasion deep or superficial to the lamina propria's muscularis mucosa, p53 expression using DO-7 and PAb1801 antibodies, age, and sex. Flow cytometry was performed on 30 patients from whom there was adequate paraffin-embedded tissue to assess DNA ploidy. Seven patients underwent immediate cystectomy as primary treatment and 36 patients retained their bladders and were at risk of recurrence and progression.
The median follow-up was 79 months. Disease recurred in 17 patients (47.2%) and progressed in 6 (16.7%). Only 3 patients (7.0%) died of bladder cancer. None of the parameters investigated was statistically significant in predicting recurrence, progression, or survival. Only carcinoma in situ approached statistical significance (P = 0.0593) as a predictor of progression. Early cystectomy did not have a significant effect on cancer-specific survival (P = 0.3603). The concordance rate between the two p53 antibodies was 88% (P <0.0001).
Deep invasion of the lamina propria, p53 positive immunohistochemistry, high grade, and aneuploidy were not significant adverse prognostic factors for either disease progression or survival. Carcinoma in situ associated with Stage T1 transitional cell carcinoma may represent a biologically more aggressive cancer requiring early definitive therapy, but this hypothesis should be evaluated in prospective clinical studies.
确定分子和组织病理学肿瘤特征是否可预测膀胱T1期移行细胞癌的疾病进展。
对43例患者的肿瘤标本进行分析，内容包括分级、原位癌的存在、侵犯黏膜固有层肌层的深浅、使用DO-7和PAb1801抗体检测p53表达、年龄和性别。对30例有足够石蜡包埋组织的患者进行流式细胞术检测以评估DNA倍体。7例患者接受了一期膀胱切除术作为主要治疗，36例患者保留膀胱，有复发和进展风险。
中位随访时间为79个月。17例患者（47.2%）疾病复发，6例（16.7%）疾病进展。仅3例患者（7.0%）死于膀胱癌。所研究的参数在预测复发、进展或生存方面均无统计学意义。仅原位癌作为进展的预测指标接近统计学意义（P = 0.0593）。早期膀胱切除术对癌症特异性生存无显著影响（P = 0.3603）。两种p53抗体之间的一致性率为88%（P <0.0001）。
黏膜固有层的深层侵犯、p53免疫组化阳性、高级别和非整倍体对于疾病进展或生存均不是显著的不良预后因素。与T1期移行细胞癌相关的原位癌可能代表生物学行为更具侵袭性的癌症，需要早期确定性治疗，但这一假设应在前瞻性临床研究中进行评估。
