USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.
USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.
Urology. 2019 Nov;133:157-163. doi: 10.1016/j.urology.2019.07.034. Epub 2019 Aug 14.
To determine if the timing of radical cystectomy for variant histology of urothelial carcinoma has an impact on survival. Variant histology has been associated with aberrant behavior compared to pure urothelial carcinoma, however the timing of surgery for these patients has not been studied.
We identified 363 patients with cT2-T4N0M0 urothelial carcinoma who underwent radical cystectomy without perioperative intravesical and/or systemic therapy from 2003 to 2014. Clinicopathologic data were compared between pure urothelial carcinoma and variant histology. The time from diagnosis to radical cystectomy was analyzed as a continuous variable and dichotomized at 4-, 8-, and 12-weeks to determine impact on oncologic outcomes.
Patients with variant histology, when compared to those with pure urothelial carcinoma, were more likely to present with extravesical disease (P <.01), be upstaged (P <.01), have lymphovascular invasion (P <.01) and have lymph node metastasis at radical cystectomy (P = .02). The median days to radical cystectomy did not differ between pure urothelial and variant histology. On multivariable analysis controlling for age, comorbidities, tumor stage, lymph node status, lymphovascular invasion, and surgical margins, every month in delay was associated with a worse overall survival for variants (HR = 1.36, P = .003). At an 8-week delay or longer, those with variant histology had a statistically worse survival (P = .03).
For patients with variant histology, delays in surgery were associated with an increased risk of death.
确定浸润性膀胱癌的非典型组织学亚型根治性膀胱切除术的时机是否对生存产生影响。与单纯尿路上皮癌相比，非典型组织学具有异常行为，然而，目前尚未研究这些患者的手术时机。
我们从 2003 年至 2014 年共确定了 363 例接受根治性膀胱切除术且未行围手术期膀胱内和/或全身治疗的 cT2-T4N0M0 尿路上皮癌患者。对单纯尿路上皮癌和非典型组织学患者的临床病理数据进行比较。从诊断到根治性膀胱切除术的时间作为连续变量进行分析，并在 4、8 和 12 周时进行二分，以确定对肿瘤学结果的影响。
与单纯尿路上皮癌患者相比，具有非典型组织学的患者更有可能出现膀胱外疾病（P<.01）、分期更高（P<.01）、有脉管侵犯（P<.01）且在根治性膀胱切除术中存在淋巴结转移（P=0.02）。单纯尿路上皮癌和非典型组织学之间，根治性膀胱切除术的中位时间无差异。在多变量分析中，控制年龄、合并症、肿瘤分期、淋巴结状态、脉管侵犯和手术切缘后，每延迟一个月，非典型组织学的总生存率越差（HR=1.36，P=0.003）。在 8 周或更长时间的延迟后，非典型组织学患者的生存状况统计学上更差（P=0.03）。
对于具有非典型组织学的患者，手术延迟与死亡风险增加相关。
