2004 年世界卫生组织组织学分类系统与 1973 年世界卫生组织系统对 Ta 原发性膀胱肿瘤的临床可靠性比较。

Clinical reliability of the 2004 WHO histological classification system compared with the 1973 WHO system for Ta primary bladder tumors.

机构信息

Department of Urology, University Vita-Salute, San Raffaele Hospital, Milan, Italy.

出版信息

J Urol. 2011 Dec;186(6):2194-9. doi: 10.1016/j.juro.2011.07.070. Epub 2011 Oct 22.

DOI:10.1016/j.juro.2011.07.070

PMID:22019037

Abstract

PURPOSE

Histopathological grade remains the most important predictive factor for the prognosis of nonmuscle invasive bladder cancer. We defined the clinical reliability of the 2004 WHO and International Society of Urological Pathology histological classification system compared with that of the 1973 WHO system for Ta primary bladder tumors.

MATERIALS AND METHODS

We evaluated 270 consecutive patients with a first episode of low grade pTa bladder cancer at transurethral resection of the bladder between 2004 and 2008. Grade was assigned by a single uropathologist simultaneously as low grade, and as G1 or G2 according to the 2004 and 1973 WHO classification systems, respectively. All patients received a single early prophylaxis instillation of 50 mg epirubicin as the only adjuvant treatment. Followup included urine cytology and cystoscopy 3 months after resection and every 6 months thereafter for 5 years. Univariate and multivariate analysis of recurrence-free and progression-free survival was done with the Kaplan-Meier method and the log rank test.

RESULTS

Mean patient age was 67.3 years (median 67, range 27 to 91). Of the patients 50 were female (18.1%) and 220 (81.9%) were male. According to the 1973 system, grade was G1 in 87 patients (32.2%) and G2 in 183 (67.8%). Median followup was 25 months (mean 27.4, range 3 to 72). The 5-year recurrence-free survival rate was 49.4% for the low grade population, and 62% and 40% for the G1 and G2 groups, respectively (p = 0.004). The 5-year progression-free survival rate was 93% for the low grade population, and 97.6% and 93.3% for the G1 and G2 groups, respectively (p = 0.06).

CONCLUSIONS

The 1973 WHO classification system predicted the risk of recurrence in primary pTa cases more accurately than the 2004 WHO system. Each classification had the same accuracy when predicting the risk of progression. Our study confirms the clinical reliability of the new histological classification in clinical practice from a prognostic point of view.

摘要

目的

组织病理学分级仍然是非肌肉浸润性膀胱癌预后的最重要预测因素。我们定义了 2004 年世界卫生组织（WHO）和国际泌尿病理学会（ISUP）组织学分类系统与 1973 年 WHO 系统在 Ta 期原发性膀胱癌中的临床可靠性。

材料与方法

我们评估了 2004 年至 2008 年间经尿道膀胱肿瘤切除术（TURBT）治疗的 270 例首次低级别 pTa 膀胱癌患者。由同一位泌尿科病理学家同时进行分级，根据 2004 年和 1973 年 WHO 分类系统，分别将低级别肿瘤分为低级别和 G1 或 G2。所有患者均接受单次早期预防膀胱灌注 50mg 表柔比星作为唯一辅助治疗。随访包括术后 3 个月行尿细胞学和膀胱镜检查，此后每 6 个月随访 5 年。采用 Kaplan-Meier 法和对数秩检验进行无复发生存和无进展生存的单因素和多因素分析。

结果

患者平均年龄为 67.3 岁（中位数 67，范围 27 至 91）。50 例患者为女性（18.1%），220 例为男性（81.9%）。根据 1973 年系统，87 例（32.2%）为 G1 级，183 例（67.8%）为 G2 级。中位随访时间为 25 个月（平均 27.4 个月，范围 3 至 72 个月）。低级别肿瘤患者的 5 年无复发生存率为 49.4%，G1 级和 G2 级分别为 62%和 40%（p=0.004）。低级别肿瘤患者的 5 年无进展生存率为 93%，G1 级和 G2 级分别为 97.6%和 93.3%（p=0.06）。