Department of Imaging, Dana-Farber Cancer Institute, 44 Binney St., Boston, MA 02115, USA.
AJR Am J Roentgenol. 2011 Jan;196(1):117-22. doi: 10.2214/AJR.10.5036.
The purpose of this study was to evaluate the metastatic pattern of muscle-invasive bladder cancer and to correlate the findings with the characteristics of the primary tumor.
From a clinic population of 392 patients with muscle-invasive (pT2-4) bladder cancer seen at our institution from January 2004 through December 2009, we studied the cases of 150 consecutively registered patients with pathologically proven metastatic disease. The metastasis-free intervals and metastatic patterns of different T categories were compared by Kruskal-Wallis test and Freeman-Halton extension of Fisher's exact test. Patients were divided into two histologic categories, those with transitional cell carcinoma and those with atypical histologic features. The metastasis-free interval and metastatic pattern of these two groups were compared by Mann-Whitney test and Fisher's exact test.
The study group consisted of 150 patients (116 men [77%], 34 women [23%]; median age, 64 years). The transitional cell carcinoma group consisted of 94 (63%) patients and the atypical histologic features group of 56 (37%) patients. The most common metastatic sites were lymph nodes (104 patients, 69%), bone (71 patients, 47%), lung (55 patients, 37%), liver (39 patients, 26%), and peritoneum (24 patients, 16%). Patients with tumors of a more advanced T category had shorter metastasis-free intervals (p = 0.001, df = 2). There was no significant difference in the metastatic patterns of tumors in the different T categories. Patients with atypical histologic features had a shorter median metastasis-free interval (3 months; range, 0-29 months) than patients with transitional cell carcinoma (12 months; range, 0-192 months) (p = 0.0001). Patients with atypical histologic features had a significantly higher incidence of peritoneal metastasis (p < 0.0002).
Lymph nodes, bones, lung, liver, and peritoneum are the most common sites of metastasis from bladder cancer. Tumors in a more advanced T category and those with atypical histologic features metastasize earlier. Tumors with atypical histologic features also have a higher frequency of peritoneal metastasis.
本研究旨在评估肌层浸润性膀胱癌的转移模式，并将其发现与原发肿瘤的特征相关联。
从 2004 年 1 月至 2009 年 12 月在我院就诊的 392 例肌层浸润性（pT2-4）膀胱癌患者的临床人群中，我们研究了 150 例连续登记的病理证实有转移疾病的患者。通过 Kruskal-Wallis 检验和 Fisher 精确检验的 Freeman-Halton 扩展比较了不同 T 分期的无转移间隔和转移模式。将患者分为两组组织学类别，即移行细胞癌组和非典型组织学特征组。通过 Mann-Whitney 检验和 Fisher 精确检验比较了这两组的无转移间隔和转移模式。
研究组包括 150 例患者（116 例男性[77%]，34 例女性[23%]；中位年龄 64 岁）。移行细胞癌组包括 94 例（63%）患者，非典型组织学特征组包括 56 例（37%）患者。最常见的转移部位是淋巴结（104 例，69%）、骨骼（71 例，47%）、肺（55 例，37%）、肝（39 例，26%）和腹膜（24 例，16%）。肿瘤 T 分期较高的患者无转移间隔较短（p = 0.001，df = 2）。不同 T 分期的肿瘤转移模式无显著差异。非典型组织学特征的患者中位无转移间隔较短（3 个月；范围，0-29 个月），移行细胞癌患者的中位无转移间隔较长（12 个月；范围，0-192 个月）（p = 0.0001）。非典型组织学特征的患者腹膜转移发生率显著较高（p < 0.0002）。
淋巴结、骨骼、肺、肝和腹膜是膀胱癌转移最常见的部位。较高 T 分期和非典型组织学特征的肿瘤转移更早。具有非典型组织学特征的肿瘤也具有更高的腹膜转移频率。
