[1973年世界卫生组织分类与世界卫生组织/国际泌尿病理学会分类在pTa期膀胱癌中的临床病理研究]

[Clinicopathological study of the 1973 who classification and the WHO/ISUP classification in pTa bladder carcinoma].

作者信息

Ishida Ryo, Tsuzuki Toyonori, Yoshida Shinri, Shiota Takako, Nisikimi Toshinori, Yamada Hiroshi, Yokoi Keisuke, Kobayashi Hiroaki

机构信息

Department of Urology, Nagoya Daini Red Cross Hospital.

出版信息

Nihon Hinyokika Gakkai Zasshi. 2010 May;101(4):609-14. doi: 10.5980/jpnjurol.101.609.

DOI:10.5980/jpnjurol.101.609

PMID:20535989

Abstract

PURPOSE

To compare the usefulness of the World Health Organization (WHO) 1973 classification with the WHO/International Society of Urological Pathology (ISUP) classification in pTa bladder tumors.

MATERIALS AND METHODS

A retrospective analysis was performed on 132 patients (107 men and 25 women; mean age 69 years) with a initial diagnosis of pTa bladder carcinoma. Median follow-up were 67 months. On the WHO 1973 classification, histopathological evaluation of initial diagnostic specimens revealed 51 cases with grade1, 68 cases with grade 2, 13 cases with grade3. All histological slides were examined by one genitourinary pathologist blinded with respect to clinical outcome and were classified according to the WHO/ISUP classification. Disease progression was defined as up stage (> or = pT1). Actual probability of progression-free and recurrence-free survival rate were estimated using the Kaplan-Meier method. The Log rank test was used to determine statistical difference between actual curves. Univariate and multivariate analyses were done using Cox regression analysis. The independent variables were multiplicity, histopathological grade, and adjuvant intravesical therapy. The dependent variable was disease progression and recurrence.

RESULTS

The tumors were reclassified as low grade carcinoma in 77 and high grade carcinoma in 55. During the follow-up, 68 patients experience recurrence, 14 patients experienced disease progression. On the WHO 1973 classification, the risk of recurrence was significantly lower in patients with grade 1 compared to those with grade3 (p = 0.007). On the WHO/ISUP classification, the risk of recurrence and disease progression were significantly lower in patients with low grade compared to those with high grade (p = 0.003, P = 0.01). After adjustment for tumor multiplicity and adjuvant therapy, the relative risks of recurrence and progression in the low grade carcinoma versus the high grade carcinoma was 2.0 (95% confidence intervals 1.26-3.31), 5.6 (95% confidence intervals 1.54-20.48).

CONCLUSIONS

In pTa bladder carcinoma, the WHO/ISUP classification was more useful prognostic factor than the WHO 1973 classification.

摘要

目的

比较世界卫生组织（WHO）1973年分类法与WHO/国际泌尿病理学会（ISUP）分类法在pTa期膀胱肿瘤中的应用价值。

材料与方法

对132例初诊为pTa期膀胱癌的患者（107例男性，25例女性；平均年龄69岁）进行回顾性分析。中位随访时间为67个月。根据WHO 1973年分类法，对初始诊断标本进行组织病理学评估，结果显示1级51例，2级68例，3级13例。所有组织学切片均由一位对临床结果不知情的泌尿生殖病理学家进行检查，并根据WHO/ISUP分类法进行分类。疾病进展定义为分期上升（≥pT1）。采用Kaplan-Meier法估计无进展生存率和无复发生存率的实际概率。采用Log rank检验确定实际曲线之间的统计学差异。使用Cox回归分析进行单因素和多因素分析。自变量为肿瘤多发情况、组织病理学分级和辅助膀胱内治疗。因变量为疾病进展和复发。

结果

肿瘤重新分类为低级别癌7例，高级别癌55例。随访期间，68例患者复发，14例患者疾病进展。根据WHO 1973年分类法，1级患者的复发风险显著低于3级患者（p = 0.007）。根据WHO/ISUP分类法，低级别患者的复发和疾病进展风险显著低于高级别患者（p = 0.003，P = 0.01）。在调整肿瘤多发情况和辅助治疗后，低级别癌与高级别癌复发和进展的相对风险分别为2.0（95%置信区间1.26 - 3.31）、5.6（95%置信区间1.54 - 20.48）。