Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD 21231, USA.
Hum Pathol. 2011 Nov;42(11):1799-803. doi: 10.1016/j.humpath.2011.03.006.
Few long-term single-center studies have addressed the outcome of patients with papillary urothelial neoplasms of low malignant potential. Our study evaluates the behavior of these tumors occurring as primary urinary bladder lesions. For this purpose, 34 primary in-house cases diagnosed and treated between 1998 and 2008 were identified from our medical records. Upon review, 3 cases were upgraded to noninvasive low-grade urothelial carcinomas and excluded from further evaluation. During follow-up (range, 3-108 months; mean, 42 months), 13 patients developed recurrences; and 9 patients progressed to a noninvasive higher grade lesion (8 to low-grade and 1 to high-grade urothelial carcinomas). None of our patients developed stage progression (>pTa) or died of bladder cancer. Size of the primary tumor was associated with the risk of recurrence (P = .043), whereas the number of episodes of recurrence was associated with the likelihood of grade progression (P = .034). In conclusion, recurrences were observed in 42% of all our patients, with a grade progression rate of 29%. None of our patients developed invasive carcinoma or died as a consequence of their disease. Considering the low but definitive risk of recurrence and grade progression, appropriate clinical follow-up of patients with primary papillary urothelial neoplasm of low malignant potential is warranted.
鲜有长期的单中心研究探讨低恶性潜能的膀胱尿路上皮乳头状肿瘤患者的结局。我们的研究评估了这些作为原发性膀胱病变发生的肿瘤的行为。为此，我们从病历中确定了 34 例 1998 年至 2008 年间诊断和治疗的原发性院内病例。经复习，3 例升级为非浸润性低级别尿路上皮癌，并排除进一步评估。在随访期间（范围 3-108 个月；平均 42 个月），13 例患者复发；9 例进展为非浸润性高级别病变（8 例为低级别，1 例为高级别尿路上皮癌）。我们没有患者进展为分期进展（>pTa）或死于膀胱癌。肿瘤大小与复发风险相关（P =.043），而复发次数与分级进展的可能性相关（P =.034）。总之，我们所有患者中有 42%观察到复发，有 29%的患者出现分级进展。我们没有患者发展为浸润性癌或因疾病死亡。考虑到复发和分级进展的风险虽低但明确，有必要对原发性低恶性潜能膀胱尿路上皮乳头状肿瘤患者进行适当的临床随访。
