Domanowska Ewa, Jozwicki Wojciech, Domaniewski Jan, Golda Ryszard, Skok Zdzislaw, Wiśniewska Halina, Sujkowska Renata, Wolski Zbigniew, Jozwicka Grazyna
Department of Clinical Pathology, The Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, Bydgoszcz, Poland.
Hum Pathol. 2007 May;38(5):741-6. doi: 10.1016/j.humpath.2006.11.001. Epub 2007 Feb 15.
Few published studies have addressed the correlation between multidirectional differentiation in muscle-invasive bladder cancer and its ability to metastasize. We demonstrated that histologic differentiation within a single tumor affects lymph node metastasis. We examined cystectomy specimens from 93 bladder tumors and 1085 lymph nodes. In this study, urothelial cell carcinomas (UCCs) with divergent differentiation, excluding pure divergent patterns such as squamous cell carcinoma and adenocarcinoma that tend toward a distinct biologic behavior, were subjected to histopathologic estimation. The positive lymph node ratio increased with the nonconventional differentiation number (NDN) within a tumor from 8.7% for an NDN of 0 (pure conventional UCCs) to 35.5% for an NDN of 2 or higher (mixed conventional and nonconventional [NC] UCCs showing >2 NC patterns). The positive lymph node number (PLN) was more than twice as high for an NDN of 3 or higher as compared with cases with an NDN of 0. Lymph node positivity (LP) was associated with the presence of micropapillary, lymphoma-like, plasmacytoid, giant cell, or clear cell-type tumors, and increasing PLN was associated with the presence of glandular, nested, lymphoma-like, plasmacytoid, or undifferentiated types in the primary tumor. By multivariate analysis, NDN status was determined to be an independent predictor of PLN (P = .032). Tumor stage had impact on LP (P = .002); however, in cases with a PLN of 4 or higher, the NDN became the only predictor of further dissemination (P = .016). No significant tumor grade impact on LP or PLN was found. Our results indicate that NC differentiation in the primary tumor is a good predictor of lymph node dissemination.
很少有已发表的研究探讨肌层浸润性膀胱癌的多向分化与其转移能力之间的相关性。我们证明了单个肿瘤内的组织学分化会影响淋巴结转移。我们检查了93例膀胱肿瘤和1085个淋巴结的膀胱切除标本。在本研究中，对具有不同分化的尿路上皮细胞癌（UCC）进行组织病理学评估，不包括倾向于独特生物学行为的纯不同模式，如鳞状细胞癌和腺癌。肿瘤内的阳性淋巴结比例随非常规分化数量（NDN）增加，NDN为0（纯常规UCC）时为8.7%，NDN为2或更高（显示>2种NC模式的混合常规和非常规[NC]UCC）时为35.5%。NDN为3或更高时的阳性淋巴结数量（PLN）是NDN为0时病例的两倍多。淋巴结阳性（LP）与微乳头、淋巴瘤样、浆细胞样、巨细胞或透明细胞型肿瘤的存在相关，而PLN增加与原发性肿瘤中腺管样、巢状、淋巴瘤样、浆细胞样或未分化类型的存在相关。通过多变量分析，确定NDN状态是PLN的独立预测因子（P = .032）。肿瘤分期对LP有影响（P = .002）；然而，在PLN为4或更高的病例中，NDN成为进一步扩散的唯一预测因子（P = .016）。未发现肿瘤分级对LP或PLN有显著影响。我们的结果表明，原发性肿瘤中的NC分化是淋巴结扩散的良好预测指标。
