Poletajew S, Fus Ł, Walędziak M, Pomada P, Ciechańska J, Wasiutyński A, Radziszewski P, Górnicka B
Sławomir Poletajew, MD, PhD, Department of Pathology, Medical University of Warsaw, Chalubinskiego 5, 00-004 Warsaw, Poland, tel. +48 601 433 488, fax +48 22 629 98 92, e-mail:
Pol J Pathol. 2014 Dec;65(4):305-12. doi: 10.5114/pjp.2014.48192.
Staging and grading of bladder cancer have a substantial impact on patients' prognosis. However, due to the relatively low quality and quantity of specimens from transurethral resection (TUR), initial histopathological examination may not be fully reliable. The aim of this study was to assess the repeatability of staging and grading in post-TUR and post-radical cystectomy (RC) specimens. Staging and grading in TUR and RC specimens were compared in a group of 181 consecutive patients. All microscopic examinations were performed by dedicated uropathologists. Median time from TUR to RC was 45 days. Additionally, an attempt to identify potential clinical variables influencing the risk of discrepancies was made. In post-RC specimens, the disease was down-staged in 13.8% and up-staged in 54.6% of patients (K = -0.03, p < 0.02). Muscle-invasive bladder cancer was diagnosed in 67.6% of patients initially staged as T1. Cancer was down-graded in 10.3% and up-graded in 17.9% of patients (K = 0.44, p < 0.02). Early onset of disease, female sex and time interval from transurethral resection of bladder tumor (TURBT) to RC had no effect on incidence of discrepancies. Pathological post-TUR examination is not predictive for the final stage of cancer. The incidence of under- or overgrading of bladder cancer is significant, and efforts should be made to reduce it.
膀胱癌的分期和分级对患者的预后有重大影响。然而，由于经尿道切除术（TUR）获取的标本质量和数量相对较低，初始组织病理学检查可能并不完全可靠。本研究的目的是评估TUR术后和根治性膀胱切除术（RC）术后标本分期和分级的可重复性。在一组181例连续患者中比较了TUR和RC标本的分期和分级。所有显微镜检查均由专业泌尿病理学家进行。从TUR到RC的中位时间为45天。此外，还尝试确定影响差异风险的潜在临床变量。在RC术后标本中，13.8%的患者疾病分期下调，54.6%的患者疾病分期上调（K=-0.03，p<0.02）。最初分期为T1的患者中，67.6%被诊断为肌层浸润性膀胱癌。10.3%的患者癌症分级下调，17.9%的患者癌症分级上调（K=0.44，p<0.02）。疾病早期发病、女性性别以及从膀胱肿瘤经尿道切除术（TURBT）到RC的时间间隔对差异发生率没有影响。TUR术后病理检查不能预测癌症的最终分期。膀胱癌分级过低或过高的发生率很高，应努力降低这一发生率。
