Brown Gordon A, Matin Surena F, Busby J Erik, Dinney Colin P N, Grossman H Barton, Pettaway Curtis A, Munsell Mark F, Kamat Ashish M
Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Urology. 2007 Aug;70(2):252-6. doi: 10.1016/j.urology.2007.03.051.
To evaluate whether the clinical grade predicts the final pathologic stage in upper urinary tract transitional cell carcinoma.
We retrospectively reviewed the records of 184 consecutive patients undergoing nephroureterectomy for upper urinary tract transitional cell carcinoma at our institution from 1986 to 2004. Their clinical, surgical, and pathologic data were reviewed to determine the positive and negative predictive values of the clinical biopsy grade with respect to the final pathologic disease stage.
Of the 184 patients, 119 (64.7%) had information available regarding the clinical grade of disease from the preoperative endoscopic biopsy. The distribution was grade 1 in 2 (1.6%), grade 2 in 46 (38.7%), and grade 3 in 71 (59.7%) patients. Of the 71 patients with grade 3 disease, 47 had Stage pT2 disease or higher (66% positive predictive value). Of the 48 patients with less than grade 3 disease, 35 had less than pT2 disease (72% negative predictive value). Of the 71 patients with grade 3 disease, 30 had pT3 disease or greater (42% positive predictive value), and of the 48 patients with less than grade 3 disease, 44 had less than pT3 disease (92% negative predictive value).
The histologic grade obtained from the diagnostic biopsy for upper urinary tract transitional cell carcinoma can be used to predict the pathologic disease stage. This information can be used to counsel patients before surgery and to identify patients for whom neoadjuvant chemotherapy would be most beneficial.
评估临床分级能否预测上尿路移行细胞癌的最终病理分期。
我们回顾性分析了1986年至2004年在我院因上尿路移行细胞癌接受肾输尿管切除术的184例连续患者的病历。对他们的临床、手术和病理数据进行审查，以确定临床活检分级对最终病理疾病分期的阳性和阴性预测价值。
184例患者中，119例（64.7%）有术前内镜活检获得的疾病临床分级信息。分布情况为：1级2例（1.6%），2级46例（38.7%），3级71例（59.7%）。在71例3级疾病患者中，47例为pT2期或更高分期（阳性预测值为66%）。在48例低于3级疾病的患者中，35例低于pT2期（阴性预测值为72%）。在71例3级疾病患者中，30例为pT3期或更高分期（阳性预测值为42%），在48例低于3级疾病的患者中，44例低于pT3期（阴性预测值为92%）。
上尿路移行细胞癌诊断活检获得的组织学分级可用于预测病理疾病分期。该信息可用于术前对患者进行咨询，并确定新辅助化疗最有益的患者。
