Department of Urology, Hirao Hospital, 6-28 Hyobu-cho, Kashihara-shi, Nara, Japan.
BMC Urol. 2011 Aug 5;11:17. doi: 10.1186/1471-2490-11-17.
We evaluated the clinical significance and prognostic value of histopathological features of bladder cancer, such as subepithelial growth patterns and tumor growth pattern at the invasion front.
In total, 130 patients newly diagnosed with non-muscle invasive bladder cancer and underwent transurethral resection between 1998 and 2009 were enrolled. Subepithelial growth patterns consisting of endophytic growth pattern (EGP) and von Brunn's nest involvement (VBNI) were investigated using hematoxylin and eosin-stained slides, and their frequency of occurrence, prognostic value, and correlation with other clinicopathological features was evaluated.
EGP and VBNI were found in 40 (30.8%) and 5 (3.9%) of the 130 cases, respectively. Of the 26 pT1 tumors, the growth pattern at the invasion front was trabecular in 17 (65.4%) and infiltrative in 9 (34.6%). Although 8 (47.1%) of 17 trabecular tumors coexisted with EGP, no cases with infiltrative tumors had EGP (p = 0.023). VBNI correlated with high tumor grades (p = 0.006) and lymphovascular involvement (p = 0.026). The multivariate Cox proportional hazards analysis revealed that tumor diameter less than 3 cm (p = 0.04) and intravesical bacillus Calmette-Guérin therapy (p = 0.004) were independent favorable prognostic factors for recurrence-free survival, whereas tumor stage was an independent poor prognostic factor for disease progression (p = 0.006).
Subepithelial growth patterns were not a significant prognostic factor in this study. Additionally, no tumors with an infiltrative growth pattern coexisted with EGP, suggesting that determining the presence of EGP might be helpful for managing non-muscle invasive bladder cancers.
我们评估了膀胱癌的组织病理学特征，如上皮下生长模式和浸润前沿的肿瘤生长模式的临床意义和预后价值。
共纳入 1998 年至 2009 年间经尿道切除的 130 例新诊断为非肌层浸润性膀胱癌患者。使用苏木精和伊红染色切片研究上皮下生长模式，包括内生长模式（EGP）和 von Brunn 巢受累（VBNI），并评估其发生频率、预后价值及其与其他临床病理特征的相关性。
130 例患者中，分别有 40 例（30.8%）和 5 例（3.9%）存在 EGP 和 VBNI。在 26 例 pT1 肿瘤中，浸润前沿的生长模式在 17 例（65.4%）为小梁状，在 9 例（34.6%）为浸润性。虽然 17 例小梁状肿瘤中有 8 例（47.1%）共存 EGP，但没有浸润性肿瘤存在 EGP（p=0.023）。VBNI 与高肿瘤分级（p=0.006）和血管淋巴管侵犯（p=0.026）相关。多变量 Cox 比例风险分析显示，肿瘤直径<3cm（p=0.04）和膀胱内卡介苗治疗（p=0.004）是无复发生存的独立有利预后因素，而肿瘤分期是疾病进展的独立不良预后因素（p=0.006）。
在本研究中，上皮下生长模式不是一个重要的预后因素。此外，没有浸润性生长模式的肿瘤与 EGP 共存，这表明确定 EGP 的存在可能有助于管理非肌层浸润性膀胱癌。
