Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD 21231, USA.
Hum Pathol. 2012 Jan;43(1):115-20. doi: 10.1016/j.humpath.2011.04.013. Epub 2011 Aug 4.
About one half of all bladder neoplasms are noninvasive, and in those, the histologic grade is a crucial prognosticator. Few single-center studies have assessed the recurrence, progression, and cancer-related mortality rates of noninvasive high-grade papillary urothelial carcinomas. With this aim, we evaluated the clinicopathologic and outcome features of 85 patients with high-grade papillary urothelial carcinoma. Median age was 68 years, and 80.5% were men. Tumor size ranged from 0.3 to 13.0 cm (median, 1.6 cm). Recurrence was found in 36.5% of the patients, whereas tumor progression, defined as invasion of lamina propria or beyond, was identified in 40% of all cases. When present, lesion reappearance involved mostly 1 to 2 episodes. Metastasis appeared in 20% of the patients, and 15% died of disseminated bladder cancer. All cancer-related deaths occurred in the group of patients with progression, whereas patients with recurrence showed similar outcomes to those with no recurrence. For patients with tumor progression, clinical stage was significantly associated with outcome (P = .002). As for prognosis, tumor size was strongly associated with progression (P < .01). In conclusion, recurrence, progression, and cancer-specific mortality rates were 36.5%, 40%, and 15%, respectively. All the patients who died of cancer had a history of tumor progression. Patients with recurrences showed similar outcomes to those with no recurrence. Tumor size was strongly associated with tumor progression and cancer-specific survival, whereas clinical stage was significantly associated with outcome in the progression group. In light of the high recurrence and progression rates of high-grade papillary urothelial carcinoma, strict clinical surveillance aimed to detect early recurrent lesions, especially in patients with larger tumors, is warranted.
大约一半的膀胱肿瘤为非浸润性，在这些肿瘤中，组织学分级是一个关键的预后指标。很少有单中心研究评估过非浸润性高级别乳头状尿路上皮癌的复发、进展和癌症相关死亡率。为此，我们评估了 85 例高级别乳头状尿路上皮癌患者的临床病理和结局特征。中位年龄为 68 岁，80.5%为男性。肿瘤大小范围为 0.3 至 13.0cm（中位数为 1.6cm）。36.5%的患者出现复发，而所有病例中有 40%被诊断为肿瘤进展，即固有层或更深处的浸润。当病变再次出现时，主要涉及 1 到 2 次发作。20%的患者出现转移，15%死于膀胱癌广泛转移。所有与癌症相关的死亡均发生在进展组的患者中，而有复发的患者与无复发的患者结局相似。对于有肿瘤进展的患者，临床分期与结局显著相关（P=0.002）。就预后而言，肿瘤大小与进展有很强的相关性（P<0.01）。总之，复发、进展和癌症特异性死亡率分别为 36.5%、40%和 15%。所有死于癌症的患者都有肿瘤进展的病史。有复发的患者与无复发的患者结局相似。肿瘤大小与肿瘤进展和癌症特异性生存有很强的相关性，而临床分期与进展组的结局显著相关。鉴于高级别乳头状尿路上皮癌的高复发和高进展率，需要进行严格的临床监测，以检测早期复发性病变，尤其是在肿瘤较大的患者中。
