膀胱癌分类的最新进展——来自世界卫生组织《泌尿系统及男性生殖器官肿瘤分类》第5版的更新

Recent Advances in the Classification of Bladder Cancer - Updates from the 5th Edition of the World Health Organization Classification of the Urinary and Male Genital Tumors.

作者信息

Guo Charles C, Shen Steven S, Czerniak Bogdan

机构信息

Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

Department of Pathology and Genomic Medicine, The Methodist Hospital, Houston, TX, USA.

出版信息

Bladder Cancer. 2023 Mar 31;9(1):1-14. doi: 10.3233/BLC-220106. eCollection 2023.

DOI:10.3233/BLC-220106

PMID:38994481

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11181758/

Abstract

BACKGROUND

The World Health Organization Classification (WHO) of Urinary and Male Genital Tumors has recently been updated to its 5th edition. The new edition presents a comprehensive approach to the classification of urinary and male genital tumors with an incorporation of morphologic, clinical, and genomic data.

OBJECTIVE

This review aims to update the new classification of bladder cancer in the 5th edition and to highlight important changes in nomenclatures, diagnostic criteria, and molecular characterization, as compared to the 4th edition.

METHODS

The pathologic classification of bladder cancer in the 5th edition of WHO Classification of Urinary and Male Genital Tumours was compared to that in the 4th edition. PubMed was searched using key words, including bladder cancer, WHO 1973, WHO 1998, WHO 2004, WHO 2016, histology, pathology, genomics, and molecular classification in the time frame from 1973 to August of 2022. Other relevant papers were also consulted, resulting in the selection of 81 papers as references.

RESULTS

The binary grading of papillary urothelial carcinoma (UC) is practical, but it may be oversimplified and contribute to "grade migration" in recent years. An arbitrary cutoff (5%) has been proposed for bladder cancers with mixed grades. The diagnosis of papillary urothelial neoplasm with low malignant potential has been dramatically reduced in recent years because of overlapping morphology and treatment with low-grade papillary UC. An inverted growth pattern should be distinguished from true (or destructive) stromal invasion in papillary UC. Several methods have been proposed for pT1 tumor substaging, but it is often challenging to substage pT1 tumors in small biopsy specimens. Bladder UC shows a high tendency for divergent differentiation, leading to several distinct histologic subtypes associated with an aggressive clinical behavior. Molecular classification based on the genomic analysis may be a useful tool in the stratification of patients for optimal treatment.

CONCLUSIONS

The 5th edition of WHO Classification of Urinary and Male Genital Tumours has made several significant changes in the classification of bladder cancer. It is important to be aware of these changes and to incorporate them into routine clinical practice.

摘要

背景

世界卫生组织（WHO）泌尿系统和男性生殖系统肿瘤分类最近已更新至第5版。新版采用综合方法对泌尿系统和男性生殖系统肿瘤进行分类，纳入了形态学、临床和基因组数据。

目的

本综述旨在更新第5版膀胱癌的新分类，并突出与第4版相比在命名、诊断标准和分子特征方面的重要变化。

方法

将《WHO泌尿系统和男性生殖系统肿瘤分类》第5版中膀胱癌的病理分类与第4版进行比较。在1973年至2022年8月期间，使用关键词“膀胱癌”“WHO 1973”“WHO 1998”“WHO 2004”“WHO 2016”“组织学”“病理学”“基因组学”和“分子分类”在PubMed上进行检索。还查阅了其他相关论文，最终选择81篇论文作为参考文献。

结果

乳头型尿路上皮癌（UC）的二元分级实用，但可能过于简化，且近年来导致“分级迁移”。对于混合分级的膀胱癌，已提出一个任意的临界值（5%）。近年来，由于形态学重叠以及与低级别乳头型UC的治疗相似，具有低恶性潜能的乳头型尿路上皮肿瘤的诊断显著减少。在乳头型UC中，应将倒置生长模式与真正的（或浸润性的）间质浸润区分开来。已提出几种pT1肿瘤亚分期的方法，但在小活检标本中对pT1肿瘤进行亚分期通常具有挑战性。膀胱UC显示出高度的异向分化倾向，导致几种与侵袭性临床行为相关的独特组织学亚型。基于基因组分析的分子分类可能是对患者进行分层以实现最佳治疗的有用工具。