根治性膀胱切除术治疗的尿路上皮膀胱癌中变异组织学的预后影响
Prognostic impact of variant histologies in urothelial bladder cancer treated with radical cystectomy.
作者信息
Claps Francesco, van de Kamp Maaike W, Mayr Roman, Bostrom Peter J, Shariat Shahrokh F, Hippe Katrin, Bertz Simone, Neuzillet Yann, Sanders Joyce, Otto Wolfgang, van der Heijden Michiel S, Jewett Michael A S, Stöhr Robert, Zlotta Alexandre R, Trombetta Carlo, Eckstein Markus, Mertens Laura S, Burger Maximilian, Soorojebally Yanish, Wullich Bernd, Bartoletti Riccardo, Radvanyi François, Pavan Nicola, Sirab Nanour, Mir M Carmen, Pouessel Damien, van der Kwast Theo H, Hartmann Arndt, Lotan Yair, Bussani Rossana, Allory Yves, van Rhijn Bas W G
机构信息
Department of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.
出版信息
BJU Int. 2023 Aug;132(2):170-180. doi: 10.1111/bju.15984. Epub 2023 Feb 20.
OBJECTIVES
To evaluate variant histologies (VHs) for disease-specific survival (DSS) in patients with invasive urothelial bladder cancer (BCa) undergoing radical cystectomy (RC).
MATERIALS AND METHODS
We analysed a multi-institutional cohort of 1082 patients treated with upfront RC for cT1-4aN0M0 urothelial BCa at eight centres. Univariable and multivariable Cox' regression analyses were used to assess the effect of different VHs on DSS in overall cohort and three stage-based analyses. The stages were defined as 'organ-confined' (≤pT2N0), 'locally advanced' (pT3-4N0) and 'node-positive' (pTanyN1-3).
RESULTS
Overall, 784 patients (72.5%) had pure urothelial carcinoma (UC), while the remaining 298 (27.5%) harboured a VH. Squamous differentiation was the most common VH, observed in 166 patients (15.3%), followed by micropapillary (40 patients [3.7%]), sarcomatoid (29 patients [2.7%]), glandular (18 patients [1.7%]), lymphoepithelioma-like (14 patients [1.3%]), small-cell (13 patients [1.2%]), clear-cell (eight patients [0.7%]), nested (seven patients [0.6%]) and plasmacytoid VH (three patients [0.3%]). The median follow-up was 2.3 years. Overall, 534 (49.4%) disease-related deaths occurred. In uni- and multivariable analyses, plasmacytoid and small-cell VHs were associated with worse DSS in the overall cohort (both P = 0.04). In univariable analyses, sarcomatoid VH was significantly associated with worse DSS, while lymphoepithelioma-like VH had favourable DSS compared to pure UC. Clear-cell (P = 0.015) and small-cell (P = 0.011) VH were associated with worse DSS in the organ-confined and node-positive cohorts, respectively.
CONCLUSIONS
More than 25% of patients harboured a VH at time of RC. Compared to pure UC, clear-cell, plasmacytoid, small-cell and sarcomatoid VHs were associated with worse DSS, while lymphoepithelioma-like VH was characterized by a DSS benefit. Accurate pathological diagnosis of VHs may ensure tailored counselling to identify patients who require more intensive management.
目的
评估接受根治性膀胱切除术（RC）的浸润性尿路上皮膀胱癌（BCa）患者的不同组织学变体（VHs）对疾病特异性生存（DSS）的影响。
材料与方法
我们分析了来自八个中心的1082例接受 upfront RC 治疗的 cT1-4aN0M0 尿路上皮 BCa 患者的多机构队列。采用单变量和多变量 Cox 回归分析评估不同 VHs 在整个队列以及三个基于分期的分析中对 DSS 的影响。分期定义为“器官局限型”（≤pT2N0）、“局部进展型”（pT3-4N0）和“淋巴结阳性型”（pTanyN1-3）。
结果
总体而言，784例患者（72.5%）患有纯尿路上皮癌（UC），其余298例（27.5%）存在 VH。鳞状分化是最常见的 VH，见于166例患者（15.3%），其次是微乳头型（40例患者[3.7%]）、肉瘤样型（29例患者[2.7%]）、腺型（18例患者[1.7%]）、淋巴上皮瘤样型（14例患者[1.3%]）、小细胞型（13例患者[1.2%]）、透明细胞型（8例患者[0.7%]）、巢状型（7例患者[0.6%]）和浆细胞样 VH（3例患者[0.3%]）。中位随访时间为2.3年。总体上，发生了534例（49.4%）与疾病相关的死亡。在单变量和多变量分析中，浆细胞样和小细胞 VH 在整个队列中与较差的 DSS 相关（均P = 0.04）。在单变量分析中，肉瘤样 VH 与较差的 DSS 显著相关，而淋巴上皮瘤样 VH 与纯 UC 相比 DSS 较好。透明细胞型（P = 0.015）和小细胞型（P = 0.011）VH 分别在器官局限型和淋巴结阳性型队列中与较差的 DSS 相关。
结论
超过25%的患者在 RC 时存在 VH。与纯 UC 相比，透明细胞型、浆细胞样型、小细胞型和肉瘤样型 VH 与较差的 DSS 相关，而淋巴上皮瘤样 VH 的特点是 DSS 较好。对 VHs 进行准确的病理诊断可确保提供个性化咨询，以识别需要更强化管理的患者。
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