Department of Urology, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan.
Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland.
Eur Urol. 2019 Apr;75(4):649-658. doi: 10.1016/j.eururo.2018.11.052. Epub 2018 Dec 13.
The optimal treatment of urothelial bladder cancer (UBC) with micropapillary (MP) variant histology is not clear.
To review the current literature on disease characteristics and treatment outcomes of MP UBC.
A systematic search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane Handbook for Systematic Reviews of Interventions. The primary end points were recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS).
We identified 758 reports comprising a total of 3154 patients, of which 28 and 15 articles were selected for qualitative and quantitative analysis, respectively. In patients with T1 MP UBC, the 5-yr CSS rates for early radical cystectomy (RC) ranged from 81% to 100%, while they were between 60% and 85% for transurethral resection of the bladder and Bacillus Calmette-Guérin (BCG). In studies reporting on neoadjuvant chemotherapy (NAC), the rates of complete pathological response (ypT0) ranged from 11% to 55%. Nevertheless, the use of NAC did not improve RFS (hazard ratio [HR] 1.23, 95% confidence interval [CI] 0.52-2.93, p=0.6), CSS (HR 0.9, 95% CI 0.48-1.7, p=0.8), or OS (HR 1.35, 95% CI 0.98-1.86, p=0.1). Fifty-three percent (95% CI 43-63%) of patients who underwent RC alone had locally advanced disease (≥pT3), and 43% (95% CI 33-52%) were harbouring lymph node metastases. MP component at RC was not significantly associated with worse RFS (HR 1.25, 95% CI 0.88-1.78, p=0.2), CSS (HR 0.96, 95% CI 0.57-1.6, p=0.9), or OS (HR 1.20, 95% CI 0.88-1.62, p=0.3) when adjusted for pathological features.
While MP UBC is associated with clinicopathological features of advanced disease, it is not associated with worse survival outcomes in patients undergoing RC. NAC results in pathological downstaging in a significant number of patients. Nevertheless, this does not translate into better survival outcomes. The optimal treatment of patients with cT1 remains controversial.
Our results suggest that micropapillary urothelial bladder cancer does not necessarily mandate different treatment algorithms. Nevertheless, each case should be discussed individually considering other clinicopathological factors.
具有微乳头状（MP）变异组织学的尿路上皮膀胱癌（UBC）的最佳治疗方法尚不清楚。
综述 MP UBC 的疾病特征和治疗结果的现有文献。
根据系统评价和荟萃分析的首选报告项目以及 Cochrane 干预措施系统评价手册进行了系统搜索。主要终点是无复发生存（RFS）、癌症特异性生存（CSS）和总生存（OS）。
我们确定了 758 份报告，共包括 3154 名患者，其中 28 份和 15 份文章分别进行了定性和定量分析。在 T1 期 MP UBC 患者中，早期根治性膀胱切除术（RC）的 5 年 CSS 率为 81%-100%，而经尿道膀胱切除术和卡介苗（BCG）的 CSS 率为 60%-85%。在报告新辅助化疗（NAC）的研究中，完全病理缓解（ypT0）率为 11%-55%。然而，NAC 的使用并未改善 RFS（风险比 [HR] 1.23，95%置信区间 [CI] 0.52-2.93，p=0.6）、CSS（HR 0.9，95% CI 0.48-1.7，p=0.8）或 OS（HR 1.35，95% CI 0.98-1.86，p=0.1）。单独接受 RC 治疗的患者中有 53%（95%CI 43%-63%）为局部晚期疾病（≥pT3），43%（95%CI 33%-52%）有淋巴结转移。RC 时的 MP 成分与较差的 RFS（HR 1.25，95% CI 0.88-1.78，p=0.2）、CSS（HR 0.96，95% CI 0.57-1.6，p=0.9）或 OS（HR 1.20，95% CI 0.88-1.62，p=0.3）无关，当调整病理特征时。
虽然 MP UBC 与晚期疾病的临床病理特征相关，但与 RC 患者的生存结果较差无关。NAC 导致大量患者的病理降期。然而，这并没有转化为更好的生存结果。cT1 患者的最佳治疗仍存在争议。
我们的结果表明，微乳头状尿路上皮膀胱癌不一定需要不同的治疗方案。然而，应根据其他临床病理因素逐个讨论每个病例。
Zotero 插件