鳞状分化预示着膀胱尿路上皮癌对顺铂化疗反应不佳及预后不良。

Squamous Differentiation Predicts Poor Response to Cisplatin-Based Chemotherapy and Unfavorable Prognosis in Urothelial Carcinoma of the Urinary Bladder.

作者信息

Minato Akinori, Fujimoto Naohiro, Kubo Tatsuhiko

机构信息

Department of Urology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.

出版信息

Clin Genitourin Cancer. 2017 Dec;15(6):e1063-e1067. doi: 10.1016/j.clgc.2017.07.008. Epub 2017 Jul 22.

DOI:10.1016/j.clgc.2017.07.008

PMID:28803791

Abstract

OBJECTIVE

The efficacy of chemotherapy on UCSD is not known. This study was conducted to investigate the efficacy of cisplatin-based chemotherapy and prognosis of patients with UC with or without SD of the bladder.

METHODS

Patients with invasive bladder cancer (clinical T3-4aN0M0) who were treated between March 2003 and March 2015 with 2 or 3 cycles of neoadjuvant chemotherapy followed by radical cystectomy were retrospectively evaluated. Treatment outcomes were compared for each pathologic type in UCSD and pure UC. The primary end point was pathologic response in the cystectomy specimens. Disease-free survival and overall survival were secondary end points.

RESULTS

We evaluated 9 patients with UCSD and 29 patients with pure UC. In the cystectomy specimens, pathologic complete response without residual tumors was not seen in any patients with UCSD, but evident in 10 patients (34.5%) with pure UC. The proportion of pathologic downstaging was significantly lower in patients with UCSD than in those with pure UC (11.1% vs. 51.7%; P = .031). Patients with UCSD had poorer disease-free survival (P < .001) and overall survival (P = .001) than those with pure UC. On multivariate Cox regression analysis, SD in UC was an independent predictor of recurrence (hazard ratio, 4.43; 95% confidence interval, 1.44-13.6, P = .009) and mortality (hazard ratio, 3.51; 95% confidence interval, 1.11-11.1, P = .032).

CONCLUSIONS

UCSD of the bladder is less sensitive to cisplatin-based chemotherapy and has poor prognosis.

摘要

目的

顺铂化疗对伴鳞状分化的尿路上皮癌（UCSD）的疗效尚不清楚。本研究旨在探讨以顺铂为基础的化疗对伴有或不伴有膀胱鳞状分化（SD）的尿路上皮癌（UC）患者的疗效及预后。

方法

对2003年3月至2015年3月期间接受2或3周期新辅助化疗后行根治性膀胱切除术的浸润性膀胱癌（临床T3 - 4aN0M0）患者进行回顾性评估。比较UCSD和单纯UC各病理类型的治疗结果。主要终点是膀胱切除标本中的病理反应。无病生存期和总生存期为次要终点。

结果

我们评估了9例UCSD患者和29例单纯UC患者。在膀胱切除标本中，UCSD患者均未出现无残留肿瘤的病理完全缓解，但10例（34.5%）单纯UC患者出现明显缓解。UCSD患者病理降期的比例显著低于单纯UC患者（11.1%对51.7%；P = 0.031）。UCSD患者的无病生存期（P < 0.001）和总生存期（P = 0.001）均较单纯UC患者差。多因素Cox回归分析显示，UC中的SD是复发（风险比，4.43；95%置信区间，1.44 - 13.6，P = 0.009）和死亡（风险比，3.51；95%置信区间，1.11 - 11.1，P = 0.032）的独立预测因素。