Denzinger Stefan, Burger Maximilian, Fritsche Hans-Martin, Bertz Simone, Hofstädter Ferdinand, Wieland Wolf F, Hartmann Arndt, Otto Wolfgang
Department of Urology, University of Regensburg, Regensburg, Germany.
Scand J Urol Nephrol. 2009;43(4):282-7. doi: 10.1080/00365590902854354.
The course of non-muscle-invasive urothelial carcinoma of the bladder (BC) staged T1G3 is hardly predictable and treatment is subject of intensive debate. In muscle-invasive BC, the infiltrative growth pattern at the tumour invasion front was able to predict patients' survival, in contrast to the nodular and trabecular growth pattern. The aim of this study was to evaluate this aspect in a series of primary T1G3 BC.
The clinical and histopathological characteristics of patients with initial T1G3 BC treated between 1990 and 2007 at a single institute were retrospectively analysed. After independent blinded reassessment by two uropathologists, 205 patients were included in the study. The mean follow-up period was 6.7 years (range 0.4-13.2 years). All patients underwent transurethral resection of the bladder and opted for either initial cystectomy (19%) or repeat resection followed by adjuvant Bacillus Calmette-Guérin (BCG) instillation therapy (81%). In total, 34% of patients were cystectomized.
The most common invasion subtype was nodular (43.9%), followed by infiltrative (42.0%) and trabecular (14.1%) growth patterns. Progression and recurrence-free survival did not differ. However, cancer-specific survival rate was statistically significantly worse in infiltrative (59.3%) than in nodular (91.1%) and trabecular (86.2%) subtypes. These results were detected in the patient subgroups with initial radical cystectomy (p<0.01) and a primary bladder-sparing approach (p=0.02). In multivariate analysis of cancer-specific survival, carcinoma in situ and growth pattern showed statistical significance.
Tumour invasion pattern may be a strong predictor of cancer-specific survival and should be considered in counselling patients in selecting appropriate therapy for T1G3 BC.
膀胱非肌层浸润性尿路上皮癌（BC）T1G3期的病程难以预测，其治疗是激烈争论的主题。与结节状和小梁状生长模式不同，在肌层浸润性BC中，肿瘤浸润前沿的浸润性生长模式能够预测患者的生存率。本研究的目的是在一系列原发性T1G3 BC中评估这一方面。
回顾性分析1990年至2007年在单一机构接受初始T1G3 BC治疗的患者的临床和组织病理学特征。经过两名泌尿病理学家独立的盲法重新评估后，205名患者被纳入研究。平均随访期为6.7年（范围0.4 - 13.2年）。所有患者均接受了经尿道膀胱切除术，其中19%选择了初始膀胱切除术，81%选择了重复切除并随后进行辅助卡介苗（BCG）灌注治疗。总共有34%的患者接受了膀胱切除术。
最常见的浸润亚型是结节状（43.9%），其次是浸润性（42.0%）和小梁状（14.1%）生长模式。进展和无复发生存率无差异。然而，浸润性亚型（59.3%）的癌症特异性生存率在统计学上显著低于结节状（91.1%）和小梁状（86.2%）亚型。这些结果在初始根治性膀胱切除术（p<0.01）和原发性保留膀胱方法（p = 0.02）的患者亚组中均有发现。在癌症特异性生存的多因素分析中，原位癌和生长模式具有统计学意义。
肿瘤浸润模式可能是癌症特异性生存的有力预测指标，在为T1G3 BC患者选择合适治疗方案的咨询过程中应予以考虑。
