Chamie Karim, Ballon-Landa Eric, Bassett Jeffrey C, Daskivich Timothy J, Leventhal Meryl, Deapen Dennis, Litwin Mark S
Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
Cancer. 2015 Feb 1;121(3):379-85. doi: 10.1002/cncr.29071. Epub 2014 Oct 22.
Muscle sampling is often used as a surrogate for staging quality in patients with bladder cancer. The association of staging quality at diagnosis and survival was examined among patients with bladder cancer.
The clinical records of all individuals within the Los Angeles Surveillance, Epidemiology, and End Results registry with an incident diagnosis of non-muscle-invasive bladder cancer in 2004-2005 were reviewed. Patient demographics, tumor characteristics, staging quality (presence of muscle in the specimen and mention of muscle in the pathology report), and vital status were recorded. With mixed-effects and competing-risks regression analyses, the association of patient and tumor characteristics with staging quality and cancer-specific survival was quantified.
The sample included 1865 patients, 335 urologists, and 27 pathologists. Muscle was reported to be present in 972 (52.1%), was reported to be absent in 564 (30.2%), and was not mentioned in 329 (17.7%) of the initial pathology reports. The presence of muscle did not differ according to the grade or depth of invasion. Mortality was associated with staging quality (P < .05). Among patients with high-grade disease, the 5-year cancer-specific mortality rates were 7.6%, 12.1%, and 18.8% when muscle was present, absent, and not mentioned, respectively.
The omission of muscle in the specimen or its mention in the pathology report in nearly half of all diagnostic resections was associated with increased mortality, particularly in patients with high-grade disease. Because urologists cannot reliably discern between high- and low-grade or Ta and T1 disease, it is contended that patients with bladder cancer should undergo adequate muscle sampling at the time of endoscopic resection.
肌肉取样常被用作膀胱癌患者分期质量的替代指标。本研究探讨了膀胱癌患者诊断时的分期质量与生存率之间的关联。
回顾了洛杉矶监测、流行病学和最终结果登记处2004 - 2005年所有初诊为非肌层浸润性膀胱癌患者的临床记录。记录患者人口统计学信息、肿瘤特征、分期质量（标本中是否有肌肉以及病理报告中是否提及肌肉）和生命状态。通过混合效应和竞争风险回归分析，对患者和肿瘤特征与分期质量及癌症特异性生存率之间的关联进行量化。
样本包括1865例患者、335名泌尿科医生和27名病理学家。在初始病理报告中，972例（52.1%）报告有肌肉，564例（30.2%）报告无肌肉，329例（17.7%）未提及肌肉。肌肉的存在与否与肿瘤分级或浸润深度无关。死亡率与分期质量相关（P < 0.05）。在高级别疾病患者中，当标本中有肌肉、无肌肉和未提及肌肉时，5年癌症特异性死亡率分别为7.6%、12.1%和18.8%。
在所有诊断性切除术中，近一半标本未取到肌肉或病理报告未提及肌肉与死亡率增加相关，尤其是在高级别疾病患者中。由于泌尿科医生无法可靠地区分高级别与低级别或Ta和T1疾病，因此认为膀胱癌患者在内镜切除时应进行充分的肌肉取样。
