Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel.
Urol Oncol. 2012 Jan-Feb;30(1):49-54. doi: 10.1016/j.urolonc.2009.11.010. Epub 2010 Mar 6.
Most urothelial carcinomas are exophytic, but some tumors exhibit subepithelial components, either in the form of endophytic growth pattern (EGP) or as von Brunn's nests involvement (VBNI). The purpose of this study was to investigate the frequency, inter-relations and clinical significance of these forms of subepithelial neoplasia in urothelial carcinoma.
Between June 1995 and December 2007, 760 patients (mean age of 67.5 years) underwent transurethral resection of bladder tumors in our institution, including 478, 157, and 112 patients with stage Ta, T1, and ≥T2 disease, respectively. Isolated or concomitant Tis were present in 137 (18%) patients. Median postoperative follow-up period was 53 months.
EGP was found in 86 cases (11.3%) and VBNI in 30 (3.9%) patients. Both forms of subepithelial growth were significantly more common in higher stage and grade tumors and were associated with each other. Multivariate analysis showed that EGP is an independent prognostic factor of stage progression (HR 4.6, P < 0.0001) and disease specific mortality (HR 2.6, P = 0.001) but not of tumor recurrence (HR 1.2, P = 0.51). VBNI was found an independent prognostic factor of tumor progression (HR 5.1, P < 0.0001), but neither of tumor recurrence nor disease specific mortality.
Subepithelial growth is not an uncommon in bladder cancer. It is more frequent in high-grade and high-stage tumors. The findings of this study suggest that subepithelial growth carries a higher risk for stage progression (EGP and VBNI) and mortality (EGP), but not tumor recurrence.
大多数尿路上皮癌为外生性，但一些肿瘤存在上皮下成分，表现为内生型生长模式（EGP）或 von Brunn 巢浸润（VBNI）。本研究旨在探讨尿路上皮癌中这些上皮下肿瘤形式的频率、相互关系和临床意义。
1995 年 6 月至 2007 年 12 月，760 例患者（平均年龄 67.5 岁）在我院接受经尿道膀胱肿瘤切除术，其中 Ta 期 478 例，T1 期 157 例，≥T2 期 112 例。137 例（18%）患者存在孤立或伴发Tis。中位术后随访时间为 53 个月。
86 例（11.3%）存在 EGP，30 例（3.9%）存在 VBNI。两种上皮下生长形式在较高分期和分级肿瘤中更为常见，且相互关联。多变量分析显示，EGP 是分期进展（HR 4.6，P<0.0001）和疾病特异性死亡率（HR 2.6，P=0.001）的独立预后因素，但不是肿瘤复发（HR 1.2，P=0.51）的独立预后因素。VBNI 是肿瘤进展（HR 5.1，P<0.0001）的独立预后因素，但不是肿瘤复发或疾病特异性死亡率的独立预后因素。
上皮下生长在膀胱癌中并不少见。它在高级别和高分期肿瘤中更为常见。本研究结果表明，上皮下生长与更高的分期进展（EGP 和 VBNI）和死亡率（EGP）相关，但与肿瘤复发无关。
