Holmäng Sten, Johansson Sonny L
Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden.
Urology. 2005 Aug;66(2):274-8. doi: 10.1016/j.urology.2005.03.011.
To compare the usefulness of World Health Organization (WHO)/International Society of Urological Pathologists 1998 consensus classification with the WHO 1999 classification in a large series of urothelial tumors of the upper urinary tract. Only a few bladder tumor studies have compared these systems.
A clinical and histopathologic review was performed of all patients diagnosed in western Sweden between 1971 and 1998 with renal pelvic or ureteral carcinoma. We selected 555 surgically treated patients who all had a urothelial tumor on review of the pathologic findings and no bladder tumor before diagnosis of the upper tract tumor. The median follow-up was 52 months. Disease-specific survival was calculated using Kaplan-Meier estimates.
A total of 349 patients had Stage pTa, pT1, or pT2 tumor, with a 5-year disease-specific survival rate of 95%, 80%, and 79%, respectively. No significant difference was found in the prognosis among papillary urothelial neoplasm of low malignant potential and low-grade and high-grade tumors of the same stage. Nor was a difference found among papillary urothelial neoplasm of low malignant potential and grade 1, 2, and 3 tumors. Of the 349 patients, 171, all with high-grade Stage pT3 tumors, had a 35% disease-specific survival rate. Of these tumors, 38 were grade 2 and 133 were grade 3, with a survival rate of 49% and 25%, respectively (P <0.0037). All 35 pT4 tumors were high grade, and no patient survived past 30 months.
Tumor stage was a very strong predictor of prognosis in this series of patients treated with open surgery. The tumor grade had little additional prognostic value, although a small advantage was found for the WHO 1999 classification, but only for high-grade, Stage pT3 tumors.
在一大系列上尿路尿路上皮肿瘤中，比较世界卫生组织（WHO）/国际泌尿病理学会1998年共识分类与WHO 1999年分类的实用性。仅有少数膀胱肿瘤研究对这些分类系统进行过比较。
对1971年至1998年期间在瑞典西部被诊断为肾盂或输尿管癌的所有患者进行临床和组织病理学回顾。我们选择了555例接受手术治疗的患者，这些患者经病理检查均患有尿路上皮肿瘤，且在上尿路肿瘤诊断之前无膀胱肿瘤。中位随访时间为52个月。采用Kaplan-Meier估计法计算疾病特异性生存率。
共有349例患者患有pTa、pT1或pT2期肿瘤，其5年疾病特异性生存率分别为95%、80%和79%。低恶性潜能乳头状尿路上皮肿瘤与相同分期的低级别和高级别肿瘤在预后方面未发现显著差异。低恶性潜能乳头状尿路上皮肿瘤与1级、2级和3级肿瘤之间也未发现差异。在这349例患者中，171例均为高级别pT3期肿瘤，其疾病特异性生存率为35%。在这些肿瘤中，38例为2级，133例为3级，生存率分别为49%和25%（P<0.0037）。所有35例pT4期肿瘤均为高级别，无患者存活超过30个月。
在这一系列接受开放手术治疗的患者中，肿瘤分期是预后的一个非常有力的预测指标。肿瘤分级几乎没有额外的预后价值，尽管发现WHO 1999年分类有一个小优势，但仅适用于高级别pT3期肿瘤。
