组织学分级 3 的存在和优势定义了 cT1HG 膀胱癌的预后分组。
Presence and predominance of histological grade 3 define cT1HG bladder cancer prognostic groups.
机构信息
Division of Unicamp and Uro-Oncology, Department of UroScience Laboratory and Pathology, Pontifical Catholic University of Campinas, PUC-Campinas, São Paulo, Brazil.
出版信息
Investig Clin Urol. 2022 Jan;63(1):21-26. doi: 10.4111/icu.20210386.
PURPOSE
Current World Health Organization/International Society of Urological Pathology (2004 WHO/ISUP) grading of bladder urothelial carcinoma relies on the highest pathologic grade of the specimen and does not reflect the inherent qualitative and quantitative heterogeneity of disease.
MATERIALS AND METHODS
We retrospectively studied consecutive urothelial high-grade cT1 (cT1HG) carcinomas submitted to adjuvant bacille Calmette-Guérin between 2008 and 2015 to evaluate the prognostic potential of grade 3 (presence or predominance) according to the 1973 WHO system concerning disease progression and cancer-specific death.
RESULTS
Among 253 patients, grading distribution was 34.4% 1+2, 7.5% 2+1, 20.2% 2+2, 19.0% 2+3, 5.1% 3+2, and 13.8% 3+3. Recurrence was diagnosed in 115 (45.5%), progression in 83 (32.8%), and cancer-specific death in 50 patients (19.8%). Mean time to recurrence, progression, and death from disease were 35.9±31.7, 47.6±44.5, and 51.2±50.4 months, respectively. Grade 3 presence (2+3, 3+2, or 3+3) occurred in 96 (37.9%) and independently predicted time to progression (p<0.001; hazard ratio [HR], 3.11; 95% confidence interval [CI], 1.88-5.14). Grade 3 predominance (3+2 or 3+3) occurred in 48 (18.9%) and independently predicted time to disease-specific death.
CONCLUSIONS
Grade 3 presence and predominance are independent predictors of progression and disease-specific death and occur in about 40% and 20% of cT1HG, respectively. Describing qualitative and quantitative heterogeneity in urothelial carcinoma grading might improve the stratification of patients. This gives three prognostic high-grade groups based on WHO/ISUP 1973: prognostic grade group I (grade 3 absence), prognostic grade group II (grade 3 presence), and prognostic grade group III (grade 3 predominance).
目的
目前世界卫生组织/国际泌尿病理学会（2004 年 WHO/ISUP）的膀胱尿路上皮癌分级依赖于标本的最高病理分级，而不能反映疾病内在的定性和定量异质性。
材料与方法
我们回顾性研究了 2008 年至 2015 年间连续接受辅助卡介苗治疗的高级别 cT1（cT1HG）尿路上皮癌患者，以评估根据 1973 年 WHO 系统中疾病进展和癌症特异性死亡的 3 级（存在或优势）分级的预后潜力。
结果
在 253 例患者中，分级分布为 34.4%为 1+2，7.5%为 2+1，20.2%为 2+2，19.0%为 2+3，5.1%为 3+2，13.8%为 3+3。115 例（45.5%）诊断为复发，83 例（32.8%）为进展，50 例（19.8%）为癌症特异性死亡。复发的平均时间、进展的平均时间和疾病特异性死亡的平均时间分别为 35.9±31.7、47.6±44.5 和 51.2±50.4 个月。存在 3 级（2+3、3+2 或 3+3）的患者为 96 例（37.9%），独立预测进展时间（p<0.001；风险比[HR]，3.11；95%置信区间[CI]，1.88-5.14）。3 级优势（3+2 或 3+3）的患者为 48 例（18.9%），独立预测疾病特异性死亡时间。
结论
3 级的存在和优势是进展和疾病特异性死亡的独立预测因素，分别发生在约 40%和 20%的 cT1HG 中。描述尿路上皮癌分级的定性和定量异质性可能会改善患者的分层。这基于 1973 年 WHO/ISUP 将患者分为三个具有预后意义的高级别组：预后分级组 I（3 级不存在）、预后分级组 II（3 级存在）和预后分级组 III（3 级优势）。
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