Department of Urology, University of Michigan, Ann Arbor, Michigan, USA.
J Urol. 2009 Jul;182(1):59-65; discussion 65. doi: 10.1016/j.juro.2009.02.116. Epub 2009 May 17.
The clinical under staging of T1 bladder cancer potentially delays therapy and undermines survival. In this study we evaluated clinicopathological features to aid in the identification of patients with clinical T1 bladder cancer at risk for under staging.
We identified patients diagnosed with clinical T1 bladder cancer who underwent cystectomy within 4 months. Muscularis propria was present and uninvolved in initial biopsies or patients had a re-staging biopsy with muscle [corrected] present. Under staging was defined as pT2 or greater, N+ or M+ disease at radical cystectomy. A logistic regression multivariable model was used for the risk of under staging. Overall survival was assessed using the Kaplan-Meier method.
Of 95 patients 26 (27%) had under staged disease. Median followup was 24 months. Compared to accurately staged cases under staged cases were more likely to have muscularis mucosae invasion (54% vs 19%, p = 0.001), mixed histology (42% vs 17%, p = 0.02) and urethral involvement (31% vs 10%, p = 0.03). In a multivariable model muscularis mucosae invasion increased the odds of under staging 9-fold (95% CI 1.5-54.5, p = 0.01). The cumulative association of these risk factors increased the odds of under staging 20-fold (95% CI 1.8-217, p = 0.0029). Median overall survival (years) was lower in patients with under staged disease (1.4 vs 10.6, p <0.001), those with muscularis mucosae invasion (2.2 vs 6.5, p = 0.04) and those with urethral involvement (25th percentile 0.8 vs 2.0, p = 0.01).
Under staging adversely impacts survival. Muscularis mucosae invasion, urethral involvement and mixed histology cumulatively increase the risk of under staging, and may be valuable in counseling patients regarding early, aggressive intervention.
T1 期膀胱癌的临床分期过低可能会延误治疗并降低生存率。本研究旨在评估临床病理特征，以帮助识别临床 T1 期膀胱癌患者中存在分期过低风险的患者。
我们确定了在 4 个月内接受膀胱切除术的临床 T1 期膀胱癌患者。初始活检中存在肌层且未受累，或患者进行了再次分期活检且存在肌层。分期过低定义为根治性膀胱切除术后 pT2 及以上、N+或 M+疾病。采用逻辑回归多变量模型评估分期过低的风险。使用 Kaplan-Meier 法评估总生存率。
95 例患者中，26 例（27%）存在分期过低。中位随访时间为 24 个月。与准确分期的病例相比，分期过低的病例更有可能存在黏膜肌层浸润（54% vs. 19%，p=0.001）、混合组织学（42% vs. 17%，p=0.02）和尿道受累（31% vs. 10%，p=0.03）。在多变量模型中，黏膜肌层浸润使分期过低的可能性增加 9 倍（95%CI 1.5-54.5，p=0.01）。这些危险因素的累积关联使分期过低的可能性增加了 20 倍（95%CI 1.8-217，p=0.0029）。分期过低的患者中位总生存率（年）较低（1.4 年 vs. 10.6 年，p<0.001），存在黏膜肌层浸润的患者（2.2 年 vs. 6.5 年，p=0.04）和存在尿道受累的患者（25%分位数 0.8 年 vs. 2.0 年，p=0.01）。
分期过低会对生存产生不利影响。黏膜肌层浸润、尿道受累和混合组织学累积增加了分期过低的风险，这可能有助于向患者提供有关早期积极干预的建议。
