Moschini Marco, Shariat Shahrokh F, Lucianò Roberta, D'Andrea David, Foerster Beat, Abufaraj Mohammad, Bandini Marco, Dell'Oglio Paolo, Damiano Rocco, Salonia Andrea, Montorsi Francesco, Briganti Alberto, Colombo Renzo, Gallina Andrea
Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, Urological Research Institute, Milan, Italy; Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy; Department of Urology, Medical University of Vienna, Vienna, Austria.
Department of Urology, Medical University of Vienna, Vienna, Austria.
Clin Genitourin Cancer. 2017 Aug;15(4):e603-e607. doi: 10.1016/j.clgc.2016.12.006. Epub 2016 Dec 14.
To evaluate the impact of pure and mixed histologic variant versus pure urothelial carcinoma in nonmetastatic bladder cancer (BCa) patients treated with radical cystectomy (RC).
We evaluated data from 1067 patients treated with RC and pelvic lymph node dissection between 1990 and 2013 at a single institution tertiary-care referral center. All specimens were evaluated by dedicated uropathologists. Univariable and multivariable Cox regression analyses tested the impact of the presence of pure and mixed histologic variants versus pure urothelial on recurrence, cancer-specific mortality, and overall mortality after accounting for all available confounders.
In total, 201 (19%) and 137 (13%) patients were found with mixed and pure variants at RC, respectively. Mixed preponderant variants were sarcomatoid, lymphoepitelial, squamous, and glandular; small-cell and micropapillary variants were found mostly as pure variants. With a median follow-up of 6.5 years, patients who harbored pure variant were found by multivariable analyses to have lower survival outcomes compared to pure urothelial carcinoma (all P < .01). Conversely, no differences were found between mixed variant versus pure urothelial by multivariable Cox regression analyses predicting recurrence, cancer-specific mortality, and overall mortality (all P > .1).
The presence of histologic variants at RC is a common finding, accounting for approximately 30% of specimens. In this setting, the presence of a pure variant but not the presence of mixed variant with urothelial carcinoma is related to a detrimental effect on survival outcomes after RC.
评估在接受根治性膀胱切除术（RC）治疗的非转移性膀胱癌（BCa）患者中，单纯组织学变异型和混合组织学变异型与单纯尿路上皮癌相比的影响。
我们评估了1990年至2013年期间在一家单一机构的三级医疗转诊中心接受RC和盆腔淋巴结清扫术的1067例患者的数据。所有标本均由专业的泌尿病理学家进行评估。在考虑所有可用混杂因素后，单变量和多变量Cox回归分析测试了单纯和混合组织学变异型与单纯尿路上皮癌的存在对复发、癌症特异性死亡率和总死亡率的影响。
总共，在RC时分别发现201例（19%）和137例（13%）患者存在混合变异型和单纯变异型。混合优势变异型为肉瘤样、淋巴上皮样、鳞状和腺性；小细胞和微乳头变异型大多为单纯变异型。中位随访6.5年，多变量分析发现，与单纯尿路上皮癌相比，存在单纯变异型的患者生存结果较差（所有P <.01）。相反，多变量Cox回归分析预测复发、癌症特异性死亡率和总死亡率时，混合变异型与单纯尿路上皮癌之间未发现差异（所有P>.1）。
RC时存在组织学变异型是一个常见发现，约占标本的30%。在这种情况下，单纯变异型的存在而非尿路上皮癌混合变异型的存在与RC后生存结果的有害影响有关。
