Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, 1090 Vienna, Austria.
Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.
Nat Rev Urol. 2017 Nov;14(11):651-668. doi: 10.1038/nrurol.2017.125. Epub 2017 Sep 12.
In the past 10 years evidence for the clinical relevance of variant histology in urinary bladder cancer has been increasing. This increase has resulted in new classifications of urothelial cancers by the WHO in 2016, highlighting the importance of an accurate morphological description of pathological specimens for the therapeutic management of patients with bladder cancer. The rising awareness of the importance of an accurate pathological report manifests itself in the increasing prevalence of reporting of variant histology in daily practice. Histological variants can generally be divided into urothelial and nonurothelial. Urothelial variants often have similar features that also have specific morphological phenotypes, whereas nonurothelial variants have independent features. Overall, histological variants follow a more aggressive clinical course than conventional urothelial carcinoma, but conclusive data on their effect on survival are currently lacking. The clinical relevance of variant histology can manifest at three different levels: diagnostic, as identification is challenging and misinterpretation is not uncommon; prognostic, for patient risk stratification and outcome estimation; and therapeutic, as particular variants could be responsive to specific treatment strategies. An accurate morphological description of histological variants is necessary for patient consultation and therapy planning. Moreover, the association of variant histology with specific mutation patterns promises to be helpful in discovering targeted therapeutic approaches based on specific molecular pathways.
在过去的 10 年中，变异组织病理学在膀胱癌中的临床相关性证据不断增加。这一增加导致 2016 年世界卫生组织（WHO）对尿路上皮癌进行了新的分类，强调了对病理标本进行准确形态描述对于膀胱癌患者治疗管理的重要性。对准确病理报告重要性的认识不断提高，表现在日常实践中报告变异组织学的比例不断增加。组织学变异一般可分为尿路上皮和非尿路上皮。尿路上皮变异通常具有相似的特征，也具有特定的形态表型，而非尿路上皮变异具有独立的特征。总体而言，组织学变异比传统尿路上皮癌具有更具侵袭性的临床病程，但目前缺乏关于其对生存影响的明确数据。变异组织学的临床相关性可以在三个不同层面表现出来：诊断层面，因为识别具有挑战性，且误诊并不少见；预后层面，用于患者风险分层和结果估计；治疗层面，因为某些特定变异可能对特定治疗策略有反应。对组织学变异进行准确的形态描述对于患者咨询和治疗计划是必要的。此外，变异组织学与特定突变模式的关联有望有助于发现基于特定分子途径的靶向治疗方法。
