Gaisa Nadine T, Wilms Holger, Wild Peter J, Jakse Gerhard, Heidenreich Axel, Knuechel Ruth
Institute of Pathology, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany.
Virchows Arch. 2015 Apr;466(4):423-32. doi: 10.1007/s00428-015-1726-7. Epub 2015 Feb 13.
Histological tumor subtyping, staging, and grading are of utmost importance to stratify patients with bladder cancer for treatment and should be as precise as possible. In the presented study, we investigated the prognostic impact of standard clinicopathological parameters in cystectomy patients and compared embedding of the entire bladder with standard partial embedding via a virtual superimposed approach. The study included 121 cystectomy specimens, which were completely embedded. Clinical and histopathological data of patients were obtained (median follow-up 21.5 months; range 1-67 months). For 88 patients two-dimensional tumor maps (macrophotographs and histology-based maps) were prepared, and embedding of the entire bladder was compared with a virtual standard partial embedding, created by a virtual overlay and data extraction of the tumor maps. Kaplan-Meier plots, Cox regression estimators, Chi-square, and McNemar tests were used. In a multivariate Cox regression model for overall survival, only venous invasion (p = 0.008, HR = 3.35, 95 % CI 1.375-8.161) and organ-confined (pTis-pT2) versus non-organ-confined diseases (pT3-pT4; p = 0.021, HR 2.669, 95 % CI 1.157-6.159) were found significant. Advanced versus standard embedding revealed significant improvement in the detection of carcinoma in situ (50 versus 61, p = 0.003) and lymphatic invasion (18 versus 24, p = 0.041), but no significant advantage in the detection of tumor stage, tumor multifocality, or venous invasion (all p > 0.05). TNM classification, including lymphatic and venous invasion, is of utmost importance to stratify patients with advanced invasive bladder cancer. Histopathological details are detected more reliably by whole organ embedding, but this approach showed no significant benefit in terms of outcome-related parameters (max. tumor stage, venous invasion) in our cohort.
组织学肿瘤亚型分类、分期和分级对于膀胱癌患者的治疗分层至关重要，且应尽可能精确。在本研究中，我们调查了膀胱切除患者标准临床病理参数的预后影响，并通过虚拟叠加方法比较了整个膀胱包埋与标准部分包埋。该研究纳入了121个完全包埋的膀胱切除标本。获取了患者的临床和组织病理学数据（中位随访时间21.5个月；范围1 - 67个月）。为88例患者制备了二维肿瘤图谱（大体照片和基于组织学的图谱），并将整个膀胱的包埋与通过虚拟叠加和肿瘤图谱数据提取创建的虚拟标准部分包埋进行比较。使用了Kaplan - Meier曲线、Cox回归估计、卡方检验和McNemar检验。在多变量Cox回归模型中，对于总生存期，仅发现静脉侵犯（p = 0.008，HR = 3.35，95% CI 1.375 - 8.161）以及器官局限性（pTis - pT2）与非器官局限性疾病（pT3 - pT4；p = 0.021，HR 2.669，95% CI 1.157 - 6.159）具有显著性。与标准包埋相比，先进包埋在原位癌（50对61，p = 0.003）和淋巴侵犯（18对24，p = 0.041）的检测方面有显著改善，但在肿瘤分期、肿瘤多灶性或静脉侵犯的检测方面无显著优势（所有p > 0.05）。包括淋巴和静脉侵犯的TNM分类对于晚期浸润性膀胱癌患者的分层至关重要。通过全器官包埋能更可靠地检测到组织病理学细节，但在我们的队列中，这种方法在与预后相关的参数（最大肿瘤分期、静脉侵犯）方面未显示出显著益处。
