Department of Urology, Mayo Clinic, Rochester, Minnesota, USA.
J Urol. 2012 Aug;188(2):405-9. doi: 10.1016/j.juro.2012.04.020. Epub 2012 Jun 14.
We investigated the clinicopathological outcomes of patients treated with cystectomy for pure urothelial carcinoma vs urothelial carcinoma, and squamous and/or glandular differentiation.
We reviewed the records of 1,013 patients who underwent radical cystectomy, including 827 (72%) with pure urothelial carcinoma and 186 (18%) with urothelial carcinoma, and squamous and/or glandular differentiation. Of patients with variant histology 132 had squamous differentiation, 41 had glandular features and 13 had each type. Cancer specific survival was estimated using the Kaplan-Meier method. The association of histological differentiation with death from bladder cancer was evaluated using multivariate Cox proportional hazard regression analysis.
Patients with urothelial carcinoma, and squamous and/or glandular differentiation were more likely to have pT3-T4 tumors (70% vs 38%, p <0.0001) and pN+ disease (20% vs 15%, p = 0.05) than those with pure urothelial carcinoma. Median followup was 11.4 years. A total of 432 patients died of bladder cancer, including 77 with histological differentiation and 355 with pure urothelial carcinoma. Ten-year cancer specific survival did not significantly differ between patients with urothelial carcinoma and histological differentiation, and those with pure urothelial carcinoma (52% vs 51%, p = 0.71). After adjusting for clinicopathological features squamous and/or glandular differentiation was not significantly associated with the risk of death from bladder cancer (HR 0.79, p = 0.10).
Patients with urothelial carcinoma, and squamous and/or glandular differentiation were more likely to have extravesical tumors and node positive disease. Nevertheless, they did not have adverse survival compared to patients with pure urothelial carcinoma. Additional studies are needed to further define prognostic factors in such patients.
我们研究了接受膀胱切除术治疗单纯尿路上皮癌与尿路上皮癌伴鳞状和/或腺分化患者的临床病理结局。
我们回顾了 1013 例接受根治性膀胱切除术患者的记录，其中 827 例（72%）为单纯尿路上皮癌，186 例（18%）为尿路上皮癌伴鳞状和/或腺分化。在具有变异组织学的患者中，132 例有鳞状分化，41 例有腺特征，13 例有每种类型。使用 Kaplan-Meier 方法估计癌症特异性生存。使用多变量 Cox 比例风险回归分析评估组织学分化与膀胱癌死亡的关系。
与单纯尿路上皮癌患者相比，尿路上皮癌伴鳞状和/或腺分化的患者更有可能患有 T3-T4 期肿瘤（70%比 38%，p<0.0001）和 pN+疾病（20%比 15%，p=0.05）。中位随访时间为 11.4 年。共有 432 例患者死于膀胱癌，其中 77 例有组织学分化，355 例有单纯尿路上皮癌。10 年癌症特异性生存率在尿路上皮癌患者和组织学分化患者与单纯尿路上皮癌患者之间无显著差异（52%比 51%，p=0.71）。在校正临床病理特征后，鳞状和/或腺分化与膀胱癌死亡风险无显著相关性（HR 0.79，p=0.10）。
尿路上皮癌伴鳞状和/或腺分化的患者更有可能患有膀胱外肿瘤和淋巴结阳性疾病。然而，与单纯尿路上皮癌患者相比，他们的生存状况并没有恶化。需要进一步的研究来进一步确定这些患者的预后因素。
