Vetterlein Malte W, Seisen Thomas, Leow Jeffrey J, Preston Mark A, Sun Maxine, Friedlander David F, Meyer Christian P, Chun Felix K-H, Lipsitz Stuart R, Menon Mani, Kibel Adam S, Bellmunt Joaquim, Choueiri Toni K, Trinh Quoc-Dien
Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, Pitié-Salpêtrière Hospital, Pierre and Marie Curie University, Paris, France.
Clin Genitourin Cancer. 2017 Aug 24. doi: 10.1016/j.clgc.2017.08.007.
Knowledge of the comparative oncologic outcomes of histologic variants after radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) relies on small case series. We compared the effect of pure squamous cell carcinoma, adenocarcinoma, and neuroendocrine carcinoma compared with pure urothelial carcinoma (PUC) on overall survival (OS) and pathologic tumor, lymph node, and surgical margin status after RC.
Using the National Cancer Database, we retrospectively examined patients undergoing RC for MIBC from 2003 to 2011. Our cohort was stratified according to histologic type and included only pure variants: squamous cell, adenocarcinoma, neuroendocrine, and PUC. Inverse probability weighting-adjusted and facility-clustered Cox and logistic regression analyses were used to assess the effect of histologic variants versus PUC on OS and pathologic outcomes.
Overall, 475 (4.4%), 224 (2.1%), 155 (1.4%), and 10,033 (92.2%) patients underwent RC for MIBC with pure squamous cell carcinoma, adenocarcinoma, neuroendocrine carcinoma, and PUC, respectively. In inverse probability weighting-adjusted analyses, squamous cell (hazard ratio, 1.26; 95% confidence interval [CI], 1.07-1.49; P = .006) and neuroendocrine (hazard ratio, 1.53; 95% CI, 1.21-1.95; P < .001) types were associated with worse OS relative to PUC. Squamous cell carcinoma (odds ratio [OR], 1.58; 95% CI, 1.23-2.04; P < .001), adenocarcinoma (OR, 1.49; 95% CI, 1.04-2.14; P = .030), and neuroendocrine carcinoma (OR, 2.37; 95% CI, 1.58-3.55; P < .001) at diagnosis were associated with greater odds of ≥ pT3 disease. The squamous cell and neuroendocrine variants were associated with decreased (OR, 0.66; 95% CI, 0.48-0.91; P = .012) and increased (OR, 1.58; 95% CI, 1.06-2.37; P = .026) odds of pN disease, respectively. Adenocarcinoma was associated with greater odds of positive margins (OR, 2.14; 95% CI, 1.39-3.30; P = .001).
Pure squamous cell and neuroendocrine carcinoma histologic types were associated with worse OS relative to PUC. However, no difference was found between adenocarcinoma and PUC. All histologic variants were associated with higher tumor stage at surgery compared with PUC.
对于肌层浸润性膀胱癌（MIBC）行根治性膀胱切除术（RC）后组织学亚型的肿瘤学比较结果的认识，依赖于小病例系列研究。我们比较了纯鳞状细胞癌、腺癌和神经内分泌癌与纯尿路上皮癌（PUC）相比，对RC术后总生存期（OS）以及病理肿瘤、淋巴结和手术切缘状态的影响。
利用国家癌症数据库，我们回顾性研究了2003年至2011年期间因MIBC接受RC的患者。我们的队列根据组织学类型进行分层，仅纳入纯亚型：鳞状细胞癌、腺癌、神经内分泌癌和PUC。采用逆概率加权调整和机构聚类的Cox回归及逻辑回归分析，评估组织学亚型与PUC相比对OS和病理结果的影响。
总体而言，分别有475例（4.4%）、224例（2.1%）、155例（1.4%）和10033例（92.2%）因MIBC接受RC的患者，其病理类型分别为纯鳞状细胞癌、腺癌、神经内分泌癌和PUC。在逆概率加权调整分析中，相对于PUC，鳞状细胞癌（风险比，1.26；95%置信区间[CI]，1.07 - 1.49；P = 0.006）和神经内分泌癌（风险比，1.53；95% CI，1.21 - 1.95；P < 0.001）与较差的OS相关。诊断时的鳞状细胞癌（优势比[OR]，1.58；95% CI，1.23 - 2.04；P < 0.001）、腺癌（OR，1.49；95% CI，1.04 - 2.14；P = 0.030）和神经内分泌癌（OR，2.37；95% CI，1.58 - 3.55；P < 0.001）与≥pT3期疾病的更高几率相关。鳞状细胞和神经内分泌变体分别与pN疾病几率降低（OR，0.66；95% CI，0.48 - 0.91；P = 0.012）和增加（OR，1.58；95% CI，1.06 - 2.37；P = 0.026）相关。腺癌与切缘阳性的更高几率相关（OR，2.14；95% CI，1.39 - 3.30；P = 0.001）。
相对于PUC，纯鳞状细胞和神经内分泌癌组织学类型与较差的OS相关。然而，腺癌和PUC之间未发现差异。与PUC相比，所有组织学变体在手术时均与更高的肿瘤分期相关。
