Department of Urology, Mayo Clinic, Rochester, Minnesota.
J Urol. 2013 Nov;190(5):1692-6. doi: 10.1016/j.juro.2013.05.040. Epub 2013 May 23.
We investigated the association of histological reclassification during pathology re-review of radical cystectomy specimens with clinicopathological outcomes in patients initially classified with urothelial carcinoma.
We identified 1,211 patients initially diagnosed with urothelial carcinoma at radical cystectomy between 1980 and 2005. All pathological specimens were re-reviewed by a urological pathologist. Survival was estimated using the Kaplan-Meier method and compared with the log rank test.
Of 1,211 cases previously recorded as pure urothelial carcinoma 406 (33%) were reclassified as variant histology. The most common variant histologies identified were squamous in 151 patients (37%) and micropapillary in 62 (15%). Variant histology on re-review was associated with a higher rate of extravesical disease (71%) than urothelial carcinoma at initial diagnosis (52%) or pure urothelial carcinoma on re-review (42%, p<0.0001). Median postoperative followup was 11.1 years, during which 976 patients died, including 564 of bladder cancer. Notably, reclassification resulted in significant stratification of 10-year cancer specific survival, which was 50% in patients with pure urothelial carcinoma after re-review, 47% in those with urothelial carcinoma on initial interpretation and 42% in those with variant histology on re-review (p=0.03). Ten-year overall survival in patients with urothelial carcinoma on re-review, urothelial carcinoma at initial interpretation and variant histology on re-review was 29%, 27% and 24%, respectively (p=0.04).
Pathological re-review of radical cystectomy specimens identified variant histology in a third of patients. These variants are associated with a high rate of locally advanced disease, which may impact the noted rates of cancer specific and overall survival. Thus, it is critical to be aware of re-review status when interpreting outcomes from historical data sets and stratifying risk.
我们研究了在对根治性膀胱切除术标本进行病理学重新审查期间进行组织学重新分类与最初诊断为尿路上皮癌患者的临床病理结果之间的关联。
我们确定了 1980 年至 2005 年间在根治性膀胱切除术时最初被诊断为尿路上皮癌的 1211 名患者。所有病理标本均由泌尿科病理学家重新审查。使用 Kaplan-Meier 方法估计生存率，并与对数秩检验进行比较。
在 1211 例先前记录为纯尿路上皮癌的病例中，有 406 例（33%）被重新分类为变异组织学。最常见的变异组织学类型为 151 例（37%）鳞状和 62 例（15%）微乳头状。重新审查时的变异组织学与更高的膀胱外疾病发生率（71%）相关，而初始诊断时的尿路上皮癌（52%）或重新审查时的纯尿路上皮癌（42%）更高（p<0.0001）。中位术后随访时间为 11.1 年，在此期间 976 例患者死亡，其中 564 例死于膀胱癌。值得注意的是，重新分类导致癌症特异性生存的 10 年分层显著，重新审查后的纯尿路上皮癌患者为 50%，初始解释时的尿路上皮癌患者为 47%，重新审查时的变异组织学患者为 42%（p=0.03）。重新审查时的尿路上皮癌患者、初始解释时的尿路上皮癌患者和重新审查时的变异组织学患者的 10 年总生存率分别为 29%、27%和 24%（p=0.04）。
根治性膀胱切除术标本的病理学重新审查确定了三分之一的患者存在变异组织学。这些变异与局部晚期疾病的高发生率相关，这可能会影响到癌症特异性和总体生存率的报告率。因此，在解释历史数据集的结果和分层风险时，了解重新审查状态非常重要。
