Mitra Anirban P, Fairey Adrian S, Skinner Eila C, Boorjian Stephen A, Frank Igor, Schoenberg Mark P, Bivalacqua Trinity J, Hyndman M Eric, Reese Adam C, Steinberg Gary D, Large Michael C, Hulsbergen-van de Kaa Christina A, Bruins Harman M, Daneshmand Siamak
Institute of Urology, University of Southern California, Los Angeles, CA.
Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada.
Urol Oncol. 2019 Jan;37(1):48-56. doi: 10.1016/j.urolonc.2018.10.013. Epub 2018 Nov 13.
To determine the association of micropapillary urothelial carcinoma (MUC) variant histology with bladder cancer outcomes after radical cystectomy.
Information on MUC patients treated with radical cystectomy was obtained from five academic centers. Data on 1,497 patients were assembled in a relational database. Tumor histology was categorized as urothelial carcinoma without any histological variants (UC; n = 1,346) or MUC (n = 151). Univariable and multivariable models were used to analyze associations with recurrence-free (RFS) and overall (OS) survival.
Median follow-up was 10.0 and 7.8 years for the UC and MUC groups, respectively. No significant differences were noted between UC and MUC groups with regard to age, gender, clinical disease stage, and administration of neoadjuvant and adjuvant chemotherapy (all, P ≥ 0.10). When compared with UC, presence of MUC was associated with higher pathologic stage (organ-confined, 60% vs. 27%; extravesical, 18% vs. 23%; node-positive, 22% vs. 50%; P < 0.01) and lymphovascular invasion (29% vs. 58%; P < 0.01) at cystectomy. In comparison with UC, MUC patients had poorer 5-year RFS (70% vs. 44%; P < 0.01) and OS (61% vs. 38%; P < 0.01). However, on multivariable analysis, tumor histology was not independently associated with the risks of recurrence (P = 0.27) or mortality (P = 0.12).
This multi-institutional analysis demonstrated that the presence of MUC was associated with locally advanced disease at radical cystectomy. However, clinical outcomes were comparable to those with pure UC after controlling for standard clinicopathologic predictors.
确定微乳头型尿路上皮癌（MUC）组织学变异与根治性膀胱切除术后膀胱癌预后的相关性。
从五个学术中心获取接受根治性膀胱切除术的MUC患者的信息。将1497例患者的数据汇总到一个关系数据库中。肿瘤组织学分类为无任何组织学变异的尿路上皮癌（UC；n = 1346）或MUC（n = 151）。使用单变量和多变量模型分析无复发生存期（RFS）和总生存期（OS）的相关性。
UC组和MUC组的中位随访时间分别为10.0年和7.8年。UC组和MUC组在年龄、性别临床疾病分期以及新辅助和辅助化疗的应用方面均未观察到显著差异（均P≥0.10）。与UC相比，MUC的存在与根治性膀胱切除时更高的病理分期相关（器官局限性，60%对27%；膀胱外，18%对23%；淋巴结阳性，22%对50%；P<0.01）和淋巴管侵犯（29%对58%；P<0.01）。与UC相比，MUC患者的5年RFS（70%对44%；P<0.01）和OS（61%对38%；P<0.01）较差。然而，在多变量分析中，肿瘤组织学与复发风险（P = 0.27）或死亡率（P = 0.12）无独立相关性。
这项多机构分析表明，MUC的存在与根治性膀胱切除时的局部晚期疾病相关。然而，在控制标准临床病理预测因素后，临床结局与单纯UC患者相当。
