Black Peter C, Brown Gordon A, Dinney Colin P N
Department of Urology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA.
Urol Oncol. 2009 Jan-Feb;27(1):3-7. doi: 10.1016/j.urolonc.2007.07.010. Epub 2008 Jan 14.
Patient risk stratification is essential for optimal management of patients with bladder cancer. Risk status determines the application and timing of therapeutic interventions such as repeat transurethral resection, intravesical chemo- and immunotherapy, systemic chemotherapy, and radical cystectomy. One key factor in such risk stratification appears to be the presence of variant histologic patterns in the bladder tumor. More than 90% of tumors are conventional urothelial carcinoma, and the rest consist of urothelial carcinoma with aberrant differentiation (squamous/glandular differentiation, small cell carcinoma, sarcomatoid carcinoma, and micropapillary carcinoma) or nonurothelial carcinoma (squamous cell carcinoma and adenocarcinoma). In this review, we focus on the implications of aberrant differentiation on the management of patients with bladder cancer. All of the variant histologies portend a worse prognosis than pure urothelial carcinoma. Although radical cystectomy remains the mainstay of treatment in all forms of bladder cancer, we highlight the use of neoadjuvant chemotherapy in patients with subtypes responsive to such therapy.
患者风险分层对于膀胱癌患者的优化管理至关重要。风险状态决定了治疗干预措施的应用和时机，如重复经尿道切除术、膀胱内化学疗法和免疫疗法、全身化疗以及根治性膀胱切除术。这种风险分层的一个关键因素似乎是膀胱肿瘤中存在变异的组织学模式。超过90%的肿瘤是传统尿路上皮癌，其余包括具有异常分化的尿路上皮癌（鳞状/腺性分化、小细胞癌、肉瘤样癌和微乳头癌）或非尿路上皮癌（鳞状细胞癌和腺癌）。在本综述中，我们重点关注异常分化对膀胱癌患者管理的影响。所有变异组织学类型的预后均比单纯尿路上皮癌差。尽管根治性膀胱切除术仍然是所有形式膀胱癌治疗的主要方法，但我们强调对有反应的亚型患者使用新辅助化疗。
