Sui Wilson, Matulay Justin T, James Maxwell B, Onyeji Ifeanyi C, Theofanides Marissa C, RoyChoudhury Arindam, DeCastro G Joel, Wenske Sven
Department of Urology, Columbia University Medical Center , New York, NY, USA.
Department of Biostatistics, Mailman School of Public Health, Columbia University , New York, NY, USA.
Bladder Cancer. 2016 Oct 27;2(4):415-423. doi: 10.3233/BLC-160066.
Micropapillary bladder cancer (MPBC) is a variant histology of urothelial carcinoma (UC) that is associated with poor outcomes however given its rarity, little is known outside of institutional reports. We sought to use a population-level cancer database to assess survival outcomes in patients treated with surgery, radiation therapy and/or chemotherapy. The National Cancer Database (NCDB) was queried for all cases of MPBC and UC using International Classification of Disease-O-3 morphologic codes between 2004-2014. Primary outcome was survival outcomes stratified by treatment modality. Treatments included radical cystectomy (RC) with or without neoadjuvant chemotherapy (NAC) or adjuvant chemotherapy (AC). Overall 869 patients with MPBC and 389,603 patients with UC met the inclusion criteria. Median age of the MPBC cohort was 69.9 years (58.9-80.9) with the majority of the cohort presenting with high-grade (89.3%) and muscle invasive or locally advanced disease (47.6%). For cT1 MPBC, outcomes of RC and BPS were not statistically different. For≥cT2 disease, NAC showed a survival benefit compared with RC alone for UC but not for MPBC. On multivariable analysis, MPBC histology independently predicted worse increased risk of death. On subanalysis of the MPBC RC patients, NAC did not improve survival outcomes compared with RC alone. Neoadjuvant chemotherapy utilization and early cystectomy did not show a survival benefit in patients with MPBC. This histology independently predicts decreased survival and prognosis is poor regardless of treatment modality. Further research should focus on developing better treatment options for this rare disease.
微乳头型膀胱癌（MPBC）是尿路上皮癌（UC）的一种组织学变异类型，其预后较差。然而，由于其罕见性，除了机构报告外，人们对它知之甚少。我们试图利用一个人群水平的癌症数据库来评估接受手术、放疗和/或化疗的患者的生存结果。我们使用2004年至2014年期间的国际疾病分类-O-3形态学编码，在国家癌症数据库（NCDB）中查询所有MPBC和UC病例。主要结局是按治疗方式分层的生存结果。治疗方法包括根治性膀胱切除术（RC），伴或不伴新辅助化疗（NAC）或辅助化疗（AC）。总体而言，869例MPBC患者和389,603例UC患者符合纳入标准。MPBC队列的中位年龄为69.9岁（58.9 - 80.9岁），该队列中的大多数患者表现为高级别（89.3%）以及肌肉浸润性或局部晚期疾病（47.6%）。对于cT1期MPBC，RC和膀胱保留手术（BPS）的结局在统计学上没有差异。对于≥cT2期疾病，NAC与单纯RC相比，对UC患者显示出生存获益，但对MPBC患者则不然。在多变量分析中，MPBC组织学独立预测死亡风险增加且情况更差。在对MPBC RC患者的亚组分析中，与单纯RC相比，NAC并未改善生存结果。新辅助化疗的应用和早期膀胱切除术在MPBC患者中未显示出生存获益。这种组织学类型独立预测生存率降低，无论治疗方式如何，预后都很差。进一步的研究应侧重于为这种罕见疾病开发更好的治疗方案。
