Department of Surgical Oncology, Mount Sinai Hospital, Toronto, Canada.
BJU Int. 2010 Jul;106(2):206-11. doi: 10.1111/j.1464-410X.2009.09100.x. Epub 2009 Dec 9.
To evaluate the effect of a pathology review on the clinical outcome of patients with primary pT1 bladder cancer (BC), as the clinical course of such patients is variable.
The slides of 164 primary (first diagnosis) pT1 bladder tumours from two university hospitals were reviewed by one pathologist for stage and grade (World Health Organization 1973 and 2004). Patients were initially managed conservatively with bacille Calmette-Guérin (BCG). Uni- and multivariate analyses compared the predictive value of age, gender, hospital, carcinoma in situ (CIS), tumour-size, reviewed grade and reviewed stage.
With a mean follow-up of 6.4 years, there was disease progression in 48 (29%) patients and 26 (16%) died from BC. Associated CIS was found in 55 (34%) patients. After reviewing the slides, 24 (15%) tumours were downstaged to pTa, 134 (82%) remained pT1 and six (4%) were upstaged to > or =pT2. The grade review resulted in 74 G2, 90 G3, 37 low-grade and 127 high-grade lesions for the two systems used. In multivariate analyses, reviewed stage (both P < 0.001) and CIS (P = 0.017 and 0.023) had independent significance for progression and disease-specific survival, respectively.
A stage review is indicated in pT1 BC, as almost 20% of pT1 tumours were up- or downstaged, and the reviewed stage predicted the patient's prognosis. Hence, pathology review identified patients with different prognoses who might benefit from other treatment strategies than BCG. We confirmed that CIS is an unfavourable sign in pT1 bladder cancer.
评估病理复查对原发性 pT1 膀胱癌（BC）患者临床结局的影响，因为这些患者的临床病程存在差异。
由一位病理学家对来自两家大学医院的 164 例原发性（首次诊断）pT1 膀胱肿瘤的切片进行复查，以评估其分期和分级（1973 年和 2004 年世界卫生组织标准）。患者最初接受卡介苗（BCG）的保守治疗。采用单因素和多因素分析比较了年龄、性别、医院、原位癌（CIS）、肿瘤大小、复查分级和复查分期的预测价值。
平均随访 6.4 年后，48 例（29%）患者出现疾病进展，26 例（16%）死于膀胱癌。55 例（34%）患者伴有 CIS。复查后，24 例（15%）肿瘤降期为 pTa，134 例（82%）仍为 pT1，6 例（4%）升期为>或=pT2。两种分级系统的复查结果分别为 74 例 G2、90 例 G3、37 例低级别和 127 例高级别病变。多因素分析显示，复查分期（均 P < 0.001）和 CIS（P = 0.017 和 0.023）对进展和疾病特异性生存均具有独立意义。
pT1BC 需进行分期复查，因为近 20%的 pT1 肿瘤存在升期或降期，且复查分期可预测患者的预后。因此，病理复查确定了具有不同预后的患者，他们可能受益于比 BCG 更有效的治疗策略。我们证实 CIS 是 pT1 膀胱癌的不利征象。
