May M, Fritsche H-M, Brookman-May S, Burger M, Bolenz C, Trojan L, Herrmann E, Michel M S, Wülfing C, Tiemann A, Müller S C, Ellinger J, Buchner A, Stief C G, Tilki D, Wieland W F, Gilfrich C, Höfner T, Hohenfellner M, Haferkamp A, Roigas J, Zacharias M, Gunia S, Bastian P J
Urologische Klinik, St. Elisabeth-Klinikum Straubing, St. Elisabeth-Straße 23, 94315, Straubing, Deutschland.
Urologe A. 2010 Dec;49(12):1508-15. doi: 10.1007/s00120-010-2424-3.
Few and partially contradictory data are available regarding the prognostic signature of downstaging of muscle-invasive clinical tumour stages in patients treated with radical cystectomy.
Clinicopathological parameters of 1,643 patients (study group, SG) treated with radical cystectomy due to muscle-invasive urothelial bladder cancer were summarized in a multi-institutional database. Patients of the SG fulfilled the following conditions: clinical tumour stage T2 N0 M0 and no administration of neoadjuvant radiation or chemotherapy. Cancer-specific survival (CSS) rates were calculated referring to pathological tumour stages in cystectomy specimens (<pT2, pT2, >pT2) (mean follow-up: 51 months). Furthermore, a multivariable model integrating clinical information was developed in order to predict the probability of downstaging.
A total of 173 patients (10.5%) of the SG presented with downstaging in pathological tumour stages (pT0: 4.8%, pTa: 0.4%, pTis: 1.3%, pT1: 4.1%); 12 of these patients had positive lymph nodes (7%, in comparison with 21% pN+ of pT2 tumours and 43% of >pT2 tumours). Patients with tumour stages <pT2, pT2 and >pT2 had CSS rates after 5 years of 89, 69 and 46%, respectively (p<0.001). In a multivariable Cox model the presence of pathological downstaging resulted in a significant reduction of cancer-specific mortality (HR 0.30; 95% CI 0.18-0.50). By logistic regression analysis the date of TURB (benefit for more recent operations) was identified as the only independent predictor for downstaging of muscle-invasive clinical tumour stages. Age, gender, grading and associated Tis in the TURB did not reveal any significant influence.
Patients with muscle-invasive clinical tumour stages and downstaging in cystectomy specimens represent a subgroup with significantly enhanced CSS rates. Further trials that integrate the parameters tumour size, stages cT2a vs cT2b and focality are required in order to define the independent prognostic signature of downstaging of tumour stages more precisely.
关于接受根治性膀胱切除术的患者中肌肉浸润性临床肿瘤分期降期的预后特征，现有的数据较少且部分相互矛盾。
一个多机构数据库汇总了1643例因肌肉浸润性尿路上皮膀胱癌接受根治性膀胱切除术患者（研究组，SG）的临床病理参数。SG组患者满足以下条件：临床肿瘤分期为T2 N0 M0，且未接受新辅助放疗或化疗。根据膀胱切除标本中的病理肿瘤分期（<pT2、pT2、>pT2）计算癌症特异性生存率（CSS）（平均随访时间：51个月）。此外，建立了一个整合临床信息的多变量模型，以预测降期的概率。
SG组共有173例患者（10.5%）病理肿瘤分期出现降期（pT0：4.8%，pTa：0.4%，pTis：1.3%，pT1：4.1%）；其中12例患者淋巴结阳性（7%，相比之下，pT2肿瘤的pN+为21%，>pT2肿瘤的pN+为43%）。肿瘤分期<pT2、pT2和>pT2的患者5年后的CSS率分别为89%、69%和46%（p<0.001）。在多变量Cox模型中，病理降期的存在导致癌症特异性死亡率显著降低（HR 0.30；95% CI 0.18 - 0.50）。通过逻辑回归分析，经尿道膀胱肿瘤切除术（TURB）的日期（近期手术更有益）被确定为肌肉浸润性临床肿瘤分期降期的唯一独立预测因素。年龄、性别、分级以及TURB中相关的Tis均未显示出任何显著影响。
肌肉浸润性临床肿瘤分期且膀胱切除标本出现降期的患者代表了一个癌症特异性生存率显著提高的亚组。需要进一步开展整合肿瘤大小、cT2a与cT2b分期以及肿瘤灶性等参数的试验，以便更精确地定义肿瘤分期降期的独立预后特征。
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