Department of Genitourinary Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA.
J Urol. 2013 May;189(5):1656-61. doi: 10.1016/j.juro.2012.11.084. Epub 2012 Nov 15.
Plasmacytoid urothelial carcinoma is a rare variant histology with poorly defined clinical behavior. We report clinical outcome information on patients with predominant plasmacytoid urothelial carcinoma.
We retrospectively analyzed treatments and outcomes in patients with predominant plasmacytoid urothelial carcinoma seen at our institution from 1990 through 2010. The Kaplan-Meier method was used to calculate overall and progression-free survival.
We identified 31 patients with a median age of 63.5 years, of whom 83.3% were male. TNM stage was cT1N0 in 4 patients, cT2N0 in 7, cT3b-4aN0 in 5 and cT4b, N+ or M+ in 15. Median overall survival was 17.7 months (stage I-III vs IV 45.8 vs 13.3). Five of the 16 patients with potentially surgically resectable plasmacytoid urothelial carcinoma (pT4aN0M0 or less) received neoadjuvant chemotherapy, 10 underwent initial surgery and 1 was treated only with transurethral resection of bladder tumor. Despite pathological down staging in 80% of the patients who received neoadjuvant chemotherapy, relapses were common. There was no survival difference between patients treated with neoadjuvant chemotherapy or initial surgery, although 7 received adjuvant chemotherapy. Surgical up staging with positive margins was also common for surgery alone. The most common site of recurrence was in the peritoneum (19 of 23 patients) with relapses even in those with a pathological complete response at surgery. In patients who presented with metastatic disease and were treated with chemotherapy median survival was 12.6 months.
Plasmacytoid urothelial carcinoma is an aggressive subset with overall poor outcomes. Although down staging is seen with neoadjuvant chemotherapy, there are few long-term survivors. There is a strong predilection for recurrence along the peritoneal lining.
浆母细胞性尿路上皮癌是一种罕见的组织学变异型，其临床行为特征尚不明确。本研究报道了以浆母细胞性尿路上皮癌为主要表现的患者的临床结局信息。
本研究回顾性分析了 1990 年至 2010 年在本机构就诊的以浆母细胞性尿路上皮癌为主要表现的患者的治疗和结局。采用 Kaplan-Meier 法计算总生存和无进展生存。
共纳入 31 例患者，中位年龄 63.5 岁，83.3%为男性。4 例患者的 TNM 分期为 cT1N0，7 例为 cT2N0，5 例为 cT3b-4aN0，15 例为 cT4b、N+或 M+。中位总生存时间为 17.7 个月（Ⅰ-Ⅲ期 vs. Ⅳ期为 45.8 个月 vs. 13.3 个月）。16 例潜在可手术切除的浆母细胞性尿路上皮癌患者（pT4aN0M0 或更低分期）中，5 例接受新辅助化疗，10 例接受初始手术，1 例仅接受经尿道膀胱肿瘤切除术。尽管接受新辅助化疗的患者中有 80%实现了病理降期，但复发仍然很常见。新辅助化疗组与初始手术组的生存无差异，尽管其中 7 例接受了辅助化疗。单纯手术组的手术切缘阳性率也较高。最常见的复发部位是腹膜（23 例患者中有 19 例），甚至在手术时达到病理完全缓解的患者中也有复发。对于有转移病灶且接受化疗的患者，中位生存时间为 12.6 个月。
浆母细胞性尿路上皮癌是一种侵袭性亚型，总体预后较差。尽管新辅助化疗可使肿瘤降期，但长期生存者很少。该肿瘤强烈倾向于沿腹膜线复发。
