Gaya Josep M, Palou Joan, Algaba Ferran, Arce Jacobo, Rodríguez-Faba Oscar, Villavicencio Humberto
Department of Urology, Fundació Puigvert, Barcelona, Spain.
Can J Urol. 2010 Oct;17(5):5370-6.
Micropapillary carcinoma is a rare pathologic variant of urothelial cell carcinoma. Intravesical bacillus Calmette-Guérin (BCG) has been reported to be ineffective and to entail an increased risk of development of non-organ-confined, metastatic disease. We assess the treatment response and disease progression in patients with micropapillary carcinoma of the bladder.
The study comprised 18 patients with micropapillary carcinoma of the bladder who underwent transurethral resection of a bladder tumor and multiple random biopsies between 1997 and 2003. We retrospectively analyzed treatment response and clinical and pathological cancer evolution related to cancer stage and the percentage of the micropapillary component of the cancer.
Seven of the 18 patients (38.8%) had carcinoma in situ. At diagnosis, 8 of the 18 patients had non-muscle-invasive bladder cancer; 6 of these patients were treated with intravesical BCG therapy and were alive and free of disease at a median follow up of more than 5 years. Ten of the 18 patients had muscle-invasive bladder cancer; 8 of these patients underwent radical cystectomy, and 7 of the 8 patients (87.5%) had non-organ-confined disease in cystectomy specimens. Seventy percent of patients with muscle-invasive disease at diagnosis had a micropapillary carcinoma component of more than 50% in transurethral resection of the bladder specimens, compared with only 25% of patients with non-muscle-invasive disease. Patients treated successfully with intravesical BCG therapy had a low micropapillary carcinoma component. The 5-year disease-specific survival rate was significantly lower in patients with muscle-invasive disease (30%) than in patients with non-muscle-invasive disease (87.5%) after a median follow up of 52 months (p = 0.001), and it was also significantly lower in patients with a high percentage of the micropapillary component of the carcinoma.
This retrospective study of 18 patients with micropapillary carcinoma of the bladder suggests that tumor stage and patient outcome may be related to the percentage of the micropapillary component of the carcinoma. Radical surgery is mandatory in muscle-invasive disease, even though patients with lymph node involvement die from the disease. In non-muscle-invasive disease and in the absence of associated carcinoma in situ, intravesical BCG treatment may be offered when the micropapillary component of the carcinoma component is a small percentage.
微乳头癌是尿路上皮癌一种罕见的病理亚型。据报道，膀胱内灌注卡介苗（BCG）对其无效，且会增加非器官局限性转移性疾病发生的风险。我们评估了膀胱微乳头癌患者的治疗反应和疾病进展情况。
本研究纳入了18例膀胱微乳头癌患者，这些患者在1997年至2003年间接受了经尿道膀胱肿瘤切除术及多次随机活检。我们回顾性分析了与癌症分期及癌症微乳头成分百分比相关的治疗反应、临床及病理癌症进展情况。
18例患者中有7例（38.8%）存在原位癌。诊断时，18例患者中有8例为非肌层浸润性膀胱癌；其中6例患者接受了膀胱内BCG治疗，在中位随访超过5年时仍存活且无疾病。18例患者中有10例为肌层浸润性膀胱癌；其中8例患者接受了根治性膀胱切除术，8例患者中的7例（87.5%）在膀胱切除标本中存在非器官局限性疾病。诊断时患有肌层浸润性疾病的患者中，70%在经尿道膀胱切除标本中的微乳头癌成分超过50%，而在非肌层浸润性疾病患者中这一比例仅为25%。成功接受膀胱内BCG治疗的患者微乳头癌成分比例较低。中位随访52个月后，肌层浸润性疾病患者的5年疾病特异性生存率（30%）显著低于非肌层浸润性疾病患者（87.5%）（p = 0.001），且癌微乳头成分比例高的患者的5年疾病特异性生存率也显著较低。
这项对18例膀胱微乳头癌患者的回顾性研究表明，肿瘤分期和患者预后可能与癌微乳头成分的百分比有关。对于肌层浸润性疾病，即使有淋巴结转移的患者最终死于该疾病，根治性手术仍是必要的。在非肌层浸润性疾病且无相关原位癌的情况下，当癌微乳头成分比例较小时，可考虑膀胱内BCG治疗。
