Frimley Health Foundation Trust - Urologia, Wexham Street, Slough, United Kingdom, UK.
Heatherwood and Wexham Park Hospitals NHS Trust, Wexham Park Hospital Wexham Slough, Slough, United Kingdom, UK.
Int Braz J Urol. 2018 Jan-Feb;44(1):45-52. doi: 10.1590/S1677-5538.IBJU.2016.0347.
Carcinosarcoma of the bladder is a very rare neoplasm. The pathogenesis of carcinosarcomas is not clearly understood and remains a subject of debate. Whilst there is some research conceptualizing the histopathological findings of bladder carcinosarcomas, the demographic features, clinical outcomes, prognosis and treatment options remain unclear.
We analyzed 12 consecutive cases of patients with sarcoma-toid bladder cancer who were treated surgically at a single Urology Department be-tween 1999 and 2015. Radiology, pathology and surgical reports were reviewed to determine the pathological staging at the time of cystectomy. These were directly compared with 230 patients having cystectomies for urothelial cell carcinoma. The sarcomatoid patients, were compared to patients with urothelial cell cancers. The other histological sub types, squamous cell (17), neuroendocrine (9), metastatic (7), mixed (4), adenocarcinoma (3), were not included.
Carcinosarcoma of the urinary bladder is often described in the literature as a highly malignant neoplasm that is rapidly lethal. We found that the sarcoma does not offer a worse prognosis than conventional high-grade urothelial car-cinoma. There is no significant difference in grade, stage, positive surgical margin rate, nodal involvement, associated prostate cancer or incidence rates of progression, all cause or disease specific mortality. There was a barely significant difference in carcinoma in-situ. However, carcinosarcomas are three times the volume of urothelial cell tumors which may contribute to its reputation as an aggressive tumour (44cc v 14cc). Sarcomatous elements do not appear, from our small study, to bestow a worse prognosis.
膀胱癌癌肉瘤是一种非常罕见的肿瘤。癌肉瘤的发病机制尚不清楚，仍存在争议。虽然有一些研究对膀胱癌癌肉瘤的组织病理学表现进行了概念化，但人口统计学特征、临床结果、预后和治疗选择仍不清楚。
我们分析了 1999 年至 2015 年间在单一泌尿科接受手术治疗的 12 例肉瘤样膀胱癌患者连续病例。回顾影像学、病理学和手术报告，以确定膀胱部分切除术时的病理分期。这些结果与 230 例接受膀胱癌根治术的患者进行了直接比较。肉瘤样患者与膀胱癌患者进行了比较。其他组织学亚型，鳞状细胞（17）、神经内分泌（9）、转移性（7）、混合性（4）、腺癌（3），不包括在本研究中。
膀胱癌癌肉瘤在文献中常被描述为一种高度恶性的肿瘤，其致死率很高。我们发现肉瘤并没有比常规的高级别尿路上皮癌预后更差。在分级、分期、阳性切缘率、淋巴结受累、前列腺癌相关、进展率、总死亡率或疾病特异性死亡率方面均无显著差异。原位癌有一点差异。然而，癌肉瘤的体积是尿路上皮肿瘤的三倍，这可能导致其被认为是一种侵袭性肿瘤（44cc 比 14cc）。从我们的小研究来看，肉瘤样成分似乎并没有带来更差的预后。
