Gofrit Ofer N, Pizov Galina, Shapiro Amos, Duvdevani Mordechai, Yutkin Vladimir, Landau Ezekiel H, Zorn Kevin C, Hidas Guy, Pode Dov
Departments of Urology and Pathology, Hadassah Hebrew University Hospital, Jerusalem, Israel, and Section of Urology, Department of Surgery, University of Montreal Health Center, Montreal, Quebec, Canada.
Departments of Urology and Pathology, Hadassah Hebrew University Hospital, Jerusalem, Israel, and Section of Urology, Department of Surgery, University of Montreal Health Center, Montreal, Quebec, Canada.
J Urol. 2014 Jun;191(6):1693-6. doi: 10.1016/j.juro.2013.11.056. Epub 2013 Dec 5.
The pathological grade of bladder cancer has an immense impact on patient treatment and prognosis. While most bladder tumors show pure high or low grade patterns, some show a mixed pattern. We explored the incidence and clinical significance of this phenomenon.
A total of 642 patients with a mean age of 67.5 years underwent transurethral resection of nonmuscle invasive bladder tumors between June 1998 and December 2008, including 156 and 454 with low and high grade lesions, respectively. In 32 patients (5%) mixed grade tumors were found, defined as low grade tumors with 10% or less of a high grade component. All patients were followed a median of 60 months postoperatively.
Mean age, the proportion of men and the proportion of stages Ta/T1 in patients with mixed grade tumors were between those of the high and low grade groups. Five-year recurrence-free survival was similar for high, low and mixed grade tumor types (56.9%, 63.8% and 66.4%, respectively, p=0.252). Five-year progression-free survival was significantly lower in patients with high grade disease (73.9%, p<0.0001) but similar in those with high and mixed grade tumors (99% and 96.9%, respectively, p=0.167). Similarly, disease specific survival was significantly worse in patients with high grade tumors (p<0.0001) but similar in those with high and mixed grade lesions (p=0.679).
Mixed grade is found in about 5% of nonmuscle invasive tumors, representing a patient group with unique clinical features. The clinical course of patients with mixed grade tumors parallels that of patients with low grade tumors.
膀胱癌的病理分级对患者的治疗和预后有巨大影响。虽然大多数膀胱肿瘤呈现单纯的高级别或低级别模式，但有些呈现混合模式。我们探讨了这种现象的发生率及临床意义。
1998年6月至2008年12月期间，共有642例平均年龄为67.5岁的患者接受了非肌层浸润性膀胱肿瘤的经尿道切除术，其中分别有156例和454例为低级别和高级别病变。在32例（5%）患者中发现了混合级别肿瘤，定义为高级别成分占比10%或更少的低级别肿瘤。所有患者术后中位随访60个月。
混合级别肿瘤患者的平均年龄、男性比例以及Ta/T1期的比例介于高级别和低级别组之间。高级别、低级别和混合级别肿瘤类型的5年无复发生存率相似（分别为56.9%、63.8%和66.4%，p = 0.252）。高级别疾病患者的5年无进展生存率显著较低（73.9%，p < 0.0001），但高级别和混合级别肿瘤患者的5年无进展生存率相似（分别为99%和96.9%，p = 0.167）。同样，高级别肿瘤患者的疾病特异性生存率显著更差（p < 0.0001），但高级别和混合级别病变患者的疾病特异性生存率相似（p = 0.679）。
约5%的非肌层浸润性肿瘤存在混合级别，代表了具有独特临床特征的患者群体。混合级别肿瘤患者的临床病程与低级别肿瘤患者相似。
