Shapur Nandakishore Kamalakar, Katz Ran, Pode Dov, Shapiro Amos, Yutkin Vladimir, Pizov Galina, Appelbaum Liat, Zorn Kevin C, Duvdevani Mordechai, Landau Ezekiel H, Gofrit Ofer N
Department of Urology, Hadassah Hebrew University Hospital, Ein Kerem, Jerusalem, Israel;
Rare Tumors. 2011 Apr 4;3(2):e22. doi: 10.4081/rt.2011.e22.
Urothelial carcinomas have an established propensity for divergent differentiation. Most of these variant tumors are muscle invasive but not all. The response of non muscle invasive variant tumors to intravesical immunotherapy with BCG is not established in the literature, and is reported here. Between June 1995 and December 2007, 760 patients (mean age of 67.5 years) underwent transurethral resection of first time bladder tumors in our institution. Histologically variant tumors were found in 79 patients (10.4%). Of these 57 patients (72%) of them had muscle-invasive disease or extensive non-muscle invasive tumors and remaining 22 patients (28%) were treated with BCG immunotherapy. These included 7 patients with squamous differentiation, 4 with glandular, 6 with nested, 4 with micropapillary and 1 patient with sarcomatoid variant. The response of these patients to immunotherapy was compared with that of 144 patients having high-grade conventional urothelial carcinomas. Median follow-up was 46 months. The 2 and 5-year progression (muscle-invasion) free survival rates were 92% and 84.24% for patients with conventional carcinoma compared to 81.06% and 63.16% for patients with variant disease (P=0.02). The 2 and 5-year disease specific survival rates were 97% and 91.43% for patients with conventional carcinoma compared to 94.74 % and 82% for patients with variant disease (P=0.33). 5 patients (22.7%) of variant group and 13 patients (9.03%) of conventional group underwent cystectomy during follow-up (P=0.068).Patients with non-muscle invasive variants of bladder cancers can be managed with intravesical immunotherapy if tumor is not bulky (>4 cm). Although progression to muscle invasive disease is more common than in conventional group and occurs in about 40% of the patients, life expectancy is similar to patients with conventional high-grade urothelial carcinomas provided that follow-up is meticulous.
尿路上皮癌具有明显的分化异质性倾向。这些变异型肿瘤大多为肌层浸润性，但并非全部如此。非肌层浸润性变异型肿瘤对卡介苗膀胱内免疫治疗的反应在文献中尚无定论，本文对此进行报道。1995年6月至2007年12月期间，我院760例患者（平均年龄67.5岁）接受了首次膀胱肿瘤经尿道切除术。组织学上发现79例（10.4%）变异型肿瘤。其中57例（72%）为肌层浸润性疾病或广泛的非肌层浸润性肿瘤，其余22例（28%）接受了卡介苗免疫治疗。这些患者包括7例鳞状分化、4例腺性、6例巢状、4例微乳头状和1例肉瘤样变异型患者。将这些患者免疫治疗的反应与144例高级别传统尿路上皮癌患者的反应进行比较。中位随访时间为46个月。传统癌患者的2年和5年无进展（肌层浸润）生存率分别为92%和84.24%，而变异型疾病患者分别为81.06%和63.16%（P = 0.02）。传统癌患者的2年和5年疾病特异性生存率分别为97%和91.43%，而变异型疾病患者分别为94.74%和82%（P = 0.33）。随访期间，变异型组5例（22.7%）和传统组13例（9.03%）患者接受了膀胱切除术（P = 0.068）。如果肿瘤体积不大（>4 cm），非肌层浸润性膀胱癌变异型患者可采用膀胱内免疫治疗。尽管进展为肌层浸润性疾病比传统组更常见，约40%的患者会出现这种情况，但只要随访细致，预期寿命与传统高级别尿路上皮癌患者相似。
