Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Eur Urol Focus. 2019 Jan;5(1):104-108. doi: 10.1016/j.euf.2017.06.013. Epub 2017 Jun 27.
BACKGROUND: The clinical significance of the plasmacytoid variant (PCV) in urothelial carcinoma (UC) is currently lacking. OBJECTIVE: To compare clinical outcomes of patients with any PCV with that of patients with pure UC treated with radical cystectomy (RC). DESIGN, SETTING, AND PARTICIPANTS: We identified 98 patients who had pathologically confirmed PCV UC and 1312 patients with pure UC and no variant history who underwent RC at our institution between 1995 and 2014. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Univariable and multivariable Cox regression and Cox proportional hazards regression to determine if PCV was associated with overall survival (OS). RESULTS AND LIMITATIONS: Patients with PCV UC were more likely to have advanced tumor stage (p=0.001), positive lymph nodes (p=0.038), and receive neoadjuvant chemotherapy than those with pure UC (46% vs 22%, p<0.0001). The rate of positive soft tissue surgical margins was over five times greater in the PCV UC group compared with the pure UC group (21% vs 4.1%, respectively, p<0.0001). Median OS for the pure UC versus the PCV patients were 8 yr and 3.8 yr, respectively. On univariable analysis, PCV was associated with an increased risk of overall mortality (hazard ratio=1.34, 95% confidence interval: 1.02-1.78, p=0.039). However, on multivariable analysis adjusted for age, sex, neoadjuvant chemotherapy received, lymph node status, pathologic stage, and soft margin status, the association between PCV and OS was no longer significant (hazard ratio=1.06, 95% confidence interval: 0.78, 1.43, p=0.7). This retrospective study is limited by the lack of pathological reanalysis, and the impact of other concurrent mixed histology cannot be determined in this study. CONCLUSIONS: Patients with PCV features have a higher disease burden at RC compared with those with pure UC. However, PCV was not an independent predictor of survival after RC on multivariable analysis, suggesting that PCV histology should not be used as an independent prognostic factor. PATIENT SUMMARY: Plasmacytoid urothelial carcinoma is a rare and aggressive form of bladder cancer. Patients with plasmacytoid urothelial carcinoma had worse adverse pathologic features, but this was not associated with worse overall mortality when compared with patients with pure urothelial carcinoma.
背景：目前尚不清楚尿路上皮癌（UC）中浆细胞样变体（PCV）的临床意义。
目的：比较接受根治性膀胱切除术（RC）治疗的任何 PCV 患者与纯 UC 患者的临床结局。
设计、设置和参与者：我们在 1995 年至 2014 年间确定了 98 例经病理证实的 PCV UC 患者和 1312 例在我院接受 RC 治疗且无变异史的纯 UC 患者。
测量和统计分析的结果：单变量和多变量 Cox 回归和 Cox 比例风险回归，以确定 PCV 是否与总生存（OS）相关。
结果和局限性：PCV UC 患者更有可能处于晚期肿瘤阶段（p=0.001）、淋巴结阳性（p=0.038）和接受新辅助化疗，而非纯 UC 患者（46%对 22%，p<0.0001）。PCV UC 组的软组织手术切缘阳性率是纯 UC 组的五倍以上（分别为 21%和 4.1%，p<0.0001）。纯 UC 组与 PCV 组患者的中位 OS 分别为 8 年和 3.8 年。单变量分析显示，PCV 与总体死亡率增加相关（风险比=1.34，95%置信区间：1.02-1.78，p=0.039）。然而，在调整年龄、性别、接受的新辅助化疗、淋巴结状态、病理分期和软切缘状态后进行多变量分析时，PCV 与 OS 之间的关联不再显著（风险比=1.06，95%置信区间：0.78，1.43，p=0.7）。本回顾性研究的局限性在于缺乏病理重新分析，并且无法确定本研究中其他并发混合组织学的影响。
结论：与纯 UC 患者相比，RC 时具有 PCV 特征的患者疾病负担更高。然而，多变量分析显示 PCV 不是 RC 后生存的独立预测因素，这表明 PCV 组织学不应作为独立的预后因素。
患者总结：浆细胞性尿路上皮癌是一种罕见且侵袭性的膀胱癌形式。与纯尿路上皮癌患者相比，浆细胞性尿路上皮癌患者具有更差的不良病理特征，但与纯尿路上皮癌患者相比，这与总体死亡率的降低无关。
Curr Treat Options Oncol. 2024-2
Int Urol Nephrol. 2022-12
Hematol Oncol Clin North Am. 2015-4
Curr Opin Urol. 2013-9
Zotero 插件