Hong Sung Kyu, Kwak Cheol, Jeon Hwang Gyun, Lee Eunsik, Lee Sang Eun
Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
Urology. 2005 Apr;65(4):697-702. doi: 10.1016/j.urology.2004.10.048.
To elucidate the respective prognostic implications of vascular, lymphatic, and perineural invasion noted on the pathologic analyses of radical cystectomy specimens. Controversy still exists on whether the pathologic features of vascular, lymphatic, and perineural invasion have any role as prognostic indicators for bladder cancer.
A retrospective review of 125 patients with bladder cancer treated with radical cystectomy was conducted. Patients who received either preoperative or postoperative chemotherapy, those with lymph node metastasis confirmed on postoperative pathologic analysis, those who did not undergo standard bilateral pelvic lymph node dissection, and those receiving palliative treatment were excluded from the study.
The mean patient age was 62.5 years (range 39 to 84), and the median follow-up duration was 41.0 months (range 1 to 146). Vascular, lymphatic, and perineural invasion was present in 8.8%, 20.8%, and 8.8% of specimens, respectively, and 28% of patients had at least one of the three pathologic features in the specimen. Univariate analysis revealed that vascular invasion, lymphatic invasion, and perineural invasion were significant prognostic predictors of overall survival. However, only the tumor stage and vascular invasion proved to be independent prognostic predictors of disease-specific survival on multivariate analysis.
The results of the present study have shown that the pathologic tumor stage and the pathologic presence of vascular invasion are independent prognostic predictors for disease-specific survival in patients who have undergone radical cystectomy for bladder cancer. Additional study should be performed on the prognostic implications of lymphatic and perineural invasion.
阐明根治性膀胱切除术标本病理分析中所发现的血管、淋巴管和神经周围侵犯各自的预后意义。血管、淋巴管和神经周围侵犯的病理特征作为膀胱癌的预后指标是否起作用仍存在争议。
对125例行根治性膀胱切除术的膀胱癌患者进行回顾性研究。接受术前或术后化疗的患者、术后病理分析证实有淋巴结转移的患者、未进行标准双侧盆腔淋巴结清扫的患者以及接受姑息治疗的患者被排除在研究之外。
患者的平均年龄为62.5岁（范围39至84岁），中位随访时间为41.0个月（范围1至146个月）。血管、淋巴管和神经周围侵犯分别出现在8.8%、20.8%和8.8%的标本中，28%的患者标本中至少有这三种病理特征之一。单因素分析显示，血管侵犯、淋巴管侵犯和神经周围侵犯是总生存的重要预后预测因素。然而，多因素分析显示只有肿瘤分期和血管侵犯是疾病特异性生存的独立预后预测因素。
本研究结果表明，病理肿瘤分期和血管侵犯的病理表现是接受膀胱癌根治性膀胱切除术患者疾病特异性生存的独立预后预测因素。应进一步研究淋巴管和神经周围侵犯的预后意义。
