From the Department of Pathology, Montefiore Medical Center, Bronx, New York (Oliver-Krasinski).
the Department of Pathology, Emory University School of Medicine, Atlanta, Georgia (Bidot, Tinsley, Harik).
Arch Pathol Lab Med. 2024 Feb 1;148(2):223-229. doi: 10.5858/arpa.2022-0268-OA.
CONTEXT.—: Noninvasive papillary urothelial carcinomas (PUCs) comprise most urinary bladder tumors. Distinction between low-grade (LG-PUC) and high-grade (HG-PUC) PUCs is pivotal for determining prognosis and subsequent treatment.
OBJECTIVE.—: To investigate the histologic characteristics of tumors with borderline features between LG-PUC and HG-PUC, focusing on the risk of recurrence and progression.
DESIGN.—: We reviewed the clinicopathologic parameters of noninvasive PUC. Tumors with borderline features were subcategorized as follows: tumors that look like LG-PUC but have occasional pleomorphic nuclei (1-BORD-NUP) or elevated mitotic count (2-BORD-MIT), and tumors with side-by-side distinct LG-PUC and less than 50% HG-PUC (3-BORD-MIXED). Recurrence-free, total progression-free, and specific invasion-free survival curves were derived from the Kaplan-Meier method, and Cox regression analysis was performed.
RESULTS.—: A total of 138 patients with noninvasive PUC were included, with the following distribution: LG-PUC (n = 52; 38%), HG-PUC (n = 34; 25%), BORD-NUP (n = 21; 15%), BORD-MIT (n = 14; 10%), and BORD-MIXED (n = 17; 12%). Median (interquartile range) follow-up was 44.2 months (29.9-73.1 months). Invasion-free survival was different between the 5 groups (P = .004), and pairwise comparison showed that HG-PUC had a worse prognosis compared with LG-PUC (P ≤ .001). On univariate Cox analysis, HG-PUC and BORD-NUP were 10.5 times (95% CI, 2.3-48.3; P = .003) and 5.9 times (95% CI, 1.1-31.9; P = .04) more likely to invade, respectively, when compared to LG-PUC.
CONCLUSIONS.—: Our findings confirm a continuous spectrum of histologic changes in PUC. Approximately a third of noninvasive PUCs show borderline features between LG-PUC and HG-PUC. Compared with LG-PUC, BORD-NUP and HG-PUC were more likely to invade on follow-up. BORD-MIXED tumors did not statistically behave differently from LG-PUC.
非浸润性乳头状尿路上皮癌（PUC）构成了大多数膀胱肿瘤。区分低级别（LG-PUC）和高级别（HG-PUC）PUC 对于确定预后和随后的治疗至关重要。
研究介于 LG-PUC 和 HG-PUC 之间的具有边界特征的肿瘤的组织学特征，重点关注复发和进展的风险。
我们回顾了非浸润性 PUC 的临床病理参数。具有边界特征的肿瘤分为以下几类：看起来像 LG-PUC 但偶尔有异型核的肿瘤（1-BORD-NUP）或有较高有丝分裂计数的肿瘤（2-BORD-MIT），以及与 LG-PUC 相邻且 HG-PUC 比例低于 50%的肿瘤（3-BORD-MIXED）。通过 Kaplan-Meier 法得出无复发生存、总无进展生存和特定无侵袭生存曲线，并进行 Cox 回归分析。
共纳入 138 例非浸润性 PUC 患者，其分布如下：LG-PUC（n=52；38%）、HG-PUC（n=34；25%）、BORD-NUP（n=21；15%）、BORD-MIT（n=14；10%）和 BORD-MIXED（n=17；12%）。中位（四分位间距）随访时间为 44.2 个月（29.9-73.1 个月）。5 组间无侵袭生存存在差异（P=.004），两两比较显示 HG-PUC 预后较 LG-PUC 差（P≤.001）。单因素 Cox 分析显示，与 LG-PUC 相比，HG-PUC 和 BORD-NUP 侵袭的可能性分别增加 10.5 倍（95%CI，2.3-48.3；P=.003）和 5.9 倍（95%CI，1.1-31.9；P=.04）。
我们的研究结果证实了 PUC 组织学变化的连续谱。大约三分之一的非浸润性 PUC 显示出介于 LG-PUC 和 HG-PUC 之间的边界特征。与 LG-PUC 相比，BORD-NUP 和 HG-PUC 在随访中更有可能侵袭。BORD-MIXED 肿瘤在统计学上与 LG-PUC 无明显差异。
