Adamczyk Przemysław, Pobłocki Paweł, Kadlubowski Mateusz, Ostrowski Adam, Wróbel Andrzej, Mikołajczak Witold, Adamowicz Jan, Drewa Tomasz, Juszczak Kajetan
Department of General and Oncologic Urology, Nicolaus Copernicus Hospital in Torun, 87-100 Torun, Poland.
Clinic of General and Oncologic Urology, Collegium Medicum, Nicolaus Copernicus University, 85-067 Bydgoszcz, Poland.
J Clin Med. 2022 Jan 30;11(3):761. doi: 10.3390/jcm11030761.
A significant number of patients with advanced urothelial cell carcinoma are under- or over-staged. Implementation of clinical variables could be useful for improving the accuracy of clinical staging.
To explore the differences between clinical and pathological diagnosis in patients with UCC, and to identify clinical variables that might play a role in under- or overstating.
A total of 553 patients after radical cystectomy were included in the analysis. Clinical stage of the disease was diagnosed according to CT or MRI in relation to clinical data.
Higher clinical stage correlated with a higher pathological stage ( < 0.00005), but in 306 patients did not correspond (142 patients were under-staged and 164 over-staged). Over half (54.2%) of the patients staged as cT1-cT2 were misdiagnosed: 137 patients were under-staged and 133 over-staged. Hydronephrosis was associated with a higher pathological stage ( < 0.000005), mostly pT3-4 (45.13% had pT4 disease) and higher risk of nodal metastasis ( = 0.0028). The highest percentage of PSM was found in patients with pT4 (33.12%).
Clinical staging of bladder cancer is poorly executed, with one third of patients under-staged and one third over-staged. To improve accuracy, we recommend a multimodal approach, combining histopathological evaluation with results of imaging studies.
大量晚期尿路上皮癌患者分期过低或过高。临床变量的应用可能有助于提高临床分期的准确性。
探讨尿路上皮癌患者临床诊断与病理诊断之间的差异，并确定可能在分期过低或过高方面起作用的临床变量。
共纳入553例行根治性膀胱切除术的患者进行分析。根据CT或MRI结合临床资料对疾病进行临床分期。
较高的临床分期与较高的病理分期相关（<0.00005），但306例患者的分期不相符（142例患者分期过低，164例患者分期过高）。分期为cT1 - cT2的患者中超过一半（54.2%）被误诊：137例患者分期过低，133例患者分期过高。肾积水与较高的病理分期相关（<0.000005），大多为pT3 - 4期（45.13%为pT4期疾病）且淋巴结转移风险较高（=0.0028）。pT4期患者的PSM百分比最高（33.12%）。
膀胱癌的临床分期执行情况不佳，三分之一的患者分期过低，三分之一的患者分期过高。为提高准确性，我们建议采用多模式方法，将组织病理学评估与影像学研究结果相结合。
