1973 年世界卫生组织分类标准比 2004 年世界卫生组织分类标准更适合预测非肌肉浸润性膀胱癌的预后。

The 1973 WHO Classification is more suitable than the 2004 WHO Classification for predicting prognosis in non-muscle-invasive bladder cancer.

机构信息

Department of Pathology, Huashan Hospital affiliated to Fudan University, Shanghai, China.

出版信息

PLoS One. 2012;7(10):e47199. doi: 10.1371/journal.pone.0047199. Epub 2012 Oct 17.

BACKGROUND

Predicting the recurrence and progression of Non-muscle-invasive bladder cancer(NMIBC) is critical for urologist. Histological grade provides significant prognostic information, especially for prediction of progression. Currently, the 1973 and the 2004 WHO classification co-exist. Which system is better for predicting rumor recurrence and progression still a matter for debate.

METHODOLOGY/PRINCIPAL FINDINGS: 348 patients diagnosed with Non-muscle invasive bladder cancer were enrolled in our retrospective study. Paraffin sections were assessed by an experienced urological pathologist according to both the 1973 and 2004 WHO classifications. Tumor recurrence and progression was followed-up in all patients. During follow-up, corresponding 5-year recurrence-free survival rates of G1, G2 and G3 were 82.1%, 55.9%, 32.1% and the 5-year progression-free survival rates were 95.9%, 84.4% and 43.3%, respectively. The 5-year recurrence-free survival rates of papillary urothelial neoplasm of low malignant potential (PUNLMP), low-grade papillary urothelial carcinoma(LGPUC) and high-grade papillary urothelial carcinoma (HGPUC) were 69.8%, 67.1% and 42.0% respectively and the 5-year progression-free survival rates were 100%, 90.9% and 54.8% respectively. In multivariate analysis, the 1973 WHO classification significantly associated with both tumor recurrence and progression(p=0.010 and p=0.022, respectively); the 2004 WHO classification correlated with tumor progression(p=0.019), while was not proved to be a variable that can predict the risk of recurrence(p=0.547). Kaplan-Meier plots showed that both the 1973 WHO and the 2004 WHO classifications were significantly associated with progression-free survival (p<0.0001, log-rank test). For prediction of recurrence, significant differences were observed between the tumor grades classified using the 1973 WHO grading system (p<0.0001, log-rank test), while a significant overlap was observed between PUNLMP and LG plots using the 2004 WHO grading system(p=0.616, log-rank test).

CONCLUSION/SIGNIFICANCE: Both the 1973 WHO and the 2004 WHO Classifications are effective in predicting tumor progression in Non-muscle invasive bladder cancer, while the 1973 WHO Classification is more suitable for predicting tumor recurrence.

背景

预测非肌肉浸润性膀胱癌（NMIBC）的复发和进展对于泌尿科医生至关重要。组织学分级提供了重要的预后信息，尤其是对进展的预测。目前，1973 年和 2004 年的世界卫生组织（WHO）分类并存。哪种系统更适合预测肿瘤复发和进展仍然存在争议。

方法/主要发现：我们对 348 例非肌肉浸润性膀胱癌患者进行了回顾性研究。病理学家根据 1973 年和 2004 年的 WHO 分类对石蜡切片进行评估。所有患者均进行了肿瘤复发和进展的随访。在随访期间，G1、G2 和 G3 的 5 年无复发生存率分别为 82.1%、55.9%和 32.1%，5 年无进展生存率分别为 95.9%、84.4%和 43.3%。低级别乳头状尿路上皮癌（LGPUC）和高级别乳头状尿路上皮癌（HGPUC）的 5 年无复发生存率分别为 67.1%和 42.0%，5 年无进展生存率分别为 90.9%和 54.8%。多变量分析显示，1973 年的 WHO 分类与肿瘤复发和进展显著相关（p=0.010 和 p=0.022）；2004 年的 WHO 分类与肿瘤进展相关（p=0.019），但不能预测复发风险（p=0.547）。Kaplan-Meier 图显示，1973 年和 2004 年的 WHO 分类均与无进展生存率显著相关（p<0.0001，对数秩检验）。对于预测复发，使用 1973 年 WHO 分级系统分级的肿瘤之间存在显著差异（p<0.0001，对数秩检验），而使用 2004 年 WHO 分级系统分级的 PUNLMP 和 LG 之间存在显著重叠（p=0.616，对数秩检验）。

结论/意义：1973 年和 2004 年的 WHO 分类均能有效预测非肌肉浸润性膀胱癌的肿瘤进展，而 1973 年的 WHO 分类更适合预测肿瘤复发。