Dutta Satya, Dey Biswajit, Raphael Vandana, Khonglah Yookarin, Mishra Jaya, Marbaniang Evarisalin, Kalita Pranjal, Sailo Stephen
Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND.
Urology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND.
Cureus. 2021 Jun 29;13(6):e16012. doi: 10.7759/cureus.16012. eCollection 2021 Jun.
Background and objective Carcinoma of the urinary bladder is the most common urological cancer, and it accounts for 3.9% of all cancer cases in men. Patients with the subset of noninvasive low-grade papillary urothelial carcinoma (LG-UrCa) are at higher risk for tumour recurrence. In this study, we aimed to analyse the histopathological features of LG-UrCa and to correlate those with recurrence potential as well as disease stage and grade progression. Materials and methods We conducted a retrospective study from January 2016 to December 2018. All cases with presenting biopsy initially reported as LG-UrCa were included in the study. All cases with initial biopsy reported as high-grade papillary urothelial carcinoma (HG-UrCa) were excluded from the study. We used the 2016 World Health Organization/International Society of Urological Pathology (WHO/ISUP) guidelines for the classification of papillary urothelial neoplasm. Results A total of 48 initially diagnosed cases of LG-UrCa were identified. Two out of 48 cases were reclassified as high-grade urothelial carcinoma and were excluded from the study. The mean age of patients at presentation was 56.7 years. The mean duration of follow-up was 19.8 months. The mean size of initial tumours was 3.4 cm. Tumour recurrence was encountered in 14 (30.4%) of 46 patients. Out of the four patients who had high-grade progression (8.7%), two also developed TNM stage progression. These two patients eventually underwent radical cystectomy. Patients with larger initial tumour sizes were found to have an increased tumour recurrence rate (p=0.009). Patients with multiple lesions at initial diagnosis had a significantly higher tumour recurrence rate than those with a single tumour (p=0.02). There was no significant difference with regard to intravesical Bacillus Calmette-Guérin (BCG) and tumour recurrence (p=0.065). None of the clinicopathological parameters were significantly associated with the grade and/or stage progression. Conclusion Based on our findings, patients with larger initial tumour size and tumour multiplicity at presentation had an increased tumour recurrence rate.
背景与目的 膀胱癌是最常见的泌尿系统癌症，占男性所有癌症病例的3.9%。非侵袭性低级别乳头状尿路上皮癌（LG-UrCa）患者的肿瘤复发风险较高。在本研究中，我们旨在分析LG-UrCa的组织病理学特征，并将其与复发潜能以及疾病分期和分级进展相关联。材料与方法 我们进行了一项从2016年1月至2018年12月的回顾性研究。所有最初活检报告为LG-UrCa的病例均纳入本研究。所有最初活检报告为高级别乳头状尿路上皮癌（HG-UrCa）的病例均被排除在本研究之外。我们使用2016年世界卫生组织/国际泌尿病理学会（WHO/ISUP）的乳头状尿路上皮肿瘤分类指南。结果 共确定了48例最初诊断为LG-UrCa的病例。48例病例中有2例被重新分类为高级别尿路上皮癌并被排除在研究之外。患者就诊时的平均年龄为56.7岁。平均随访时间为19.8个月。初始肿瘤的平均大小为3.4厘米。46例患者中有14例（30.4%）出现肿瘤复发。在4例发生高级别进展的患者中（8.7%），有2例也出现了TNM分期进展。这两名患者最终接受了根治性膀胱切除术。发现初始肿瘤较大的患者肿瘤复发率增加（p=0.009）。初始诊断时有多个病灶的患者肿瘤复发率明显高于单一肿瘤患者（p=0.02）。膀胱内卡介苗（BCG）与肿瘤复发之间无显著差异（p=0.065）。没有任何临床病理参数与分级和/或分期进展显著相关。结论 根据我们的研究结果，就诊时初始肿瘤较大和肿瘤多发的患者肿瘤复发率增加。
