Lipponen P K
Department of Pathology, University of Kuopio, Finland.
Anticancer Res. 1992 Sep-Oct;12(5):1527-32.
A cohort of 103 transitional cell bladder tumours (TCC) treated by cystectomy was followed up over 9 years. Patients treated with radiation and cystectomy had a more unfavorable prognosis than patients treated by cystectomy alone (p < 0.0001). Old patients had an unfavorable prognosis after cystectomy, whereas none of the patients under the age of 50 died of TCC after cystectomy (p = 0.027). WHO grade (p = 0.002), high mitotic rate (p = 0.012) and nodular growth pattern (p = 0.004) were signs of ominous disease outcome in univariate survival analysis. Dense inflammatory cell infiltrates in the tumour itself or around invasive tumour cells were signs of good prognosis after cystectomy (p = 0.001) in a multivariate analysis. Clinical stage or nuclear morphometric factors had no independent prognostic value after cystectomy. The results clearly show that the intrinsic malignancy of TCC and host defence mechanisms together determine the prognosis after cystectomy. The evaluation of malignant features in TCC alone is an insufficient means of predicting prognosis in invasive TCC and the analysis of host immune response should be included in the prognostic evaluation.
对103例接受膀胱切除术治疗的移行细胞膀胱癌（TCC）患者进行了9年的随访。接受放疗和膀胱切除术治疗的患者预后比仅接受膀胱切除术治疗的患者更差（p < 0.0001）。老年患者膀胱切除术后预后不良，而50岁以下患者膀胱切除术后无一例死于TCC（p = 0.027）。在单因素生存分析中，世界卫生组织分级（p = 0.002）、高有丝分裂率（p = 0.012）和结节状生长模式（p = 0.004）是疾病预后不良的迹象。在多因素分析中，肿瘤本身或浸润性肿瘤细胞周围密集的炎性细胞浸润是膀胱切除术后预后良好的迹象（p = 0.001）。膀胱切除术后临床分期或核形态计量学因素无独立的预后价值。结果清楚地表明，TCC的内在恶性程度和宿主防御机制共同决定了膀胱切除术后的预后。仅评估TCC中的恶性特征不足以预测浸润性TCC的预后，预后评估应包括宿主免疫反应的分析。
