Wood Andrew M, Benidir Tarik, Campbell Rebecca, Li Jianbo, Lone Zaeem, Haywood Samuel, Eltemamy Mohamed, Weight Christopher J, Haber Georges-Pascal, Almassi Nima, Alaghehbandan Reza
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
Urol Oncol. 2025 Apr;43(4):266.e1-266.e7. doi: 10.1016/j.urolonc.2024.09.005. Epub 2024 Oct 5.
INTRODUCTION/BACKGROUND: Micropapillary variant urothelial carcinoma (MPUC) is associated with increased risk of treatment failure with intravesical therapy likely due to the increased risk of occult lymph node (LN) metastasis at radical cystectomy (RC). To date, limited data exists as to whether percent MPUC present within transurethral resection (TUR) samples impacts LN positivity at RC. Our objective is to evaluate the association of percentage MP variant on TUR on incidence of lymph node metastasis and survival outcomes.
A total of 67 patients with MPUC on TUR were identified from a prospectively maintained database of patients undergoing RC at our institution between 2007 and 2022. TUR samples were rereviewed by an expert GU pathologist with over ten years of experience. Presence and percent MP component, LVI, CIS, grade, and clinical stage were evaluated. Pathologic outcomes were collected from subsequent RC specimens, and recurrence free (RFS) and overall survival (OS) were estimated via the Kaplan-Meier method. Associations between percent MP and lymph node metastasis, RFS, and OS were assessed with univariate and multivariable logistic regression and Cox survival analyses as appropriate.
Thirty four of 67 (51%) patients underwent RC for cT1 disease, the remainder harbored ≥cT2 disease. 19 of 33 (58%) patients with ≥cT2 disease received neoadjuvant chemotherapy (NAC). Mean percent MPUC was 35% in cT1 patients and 28% in cT2 patients (P = 0.25). On univariate analysis, both MPUC ≥ 30% (Odds Ratio (OR) 3.38, P = 0.02) and clinical ≥T2 (OR 2.88, P = 0.04) were significant predictors of nodal metastasis at RC. On multivariable analysis, MPUC% (OR 1.02, P = 0.036) or MPUC% ≥ 30% (OR 4.01, P = 0.013) and clinical T stage ≥2 (OR 3.73, P = 0.018) were significant predictors of pathologic node positive disease. The lowest rate of LN metastasis was found in patients with cT1 disease and MPUC <30% (3/16, 18.7%), versus the highest in ≥cT2 disease and MP ≥ 30% (12/16, 75%).
Percent MPUC component on TUR is associated with increased risk of occult lymph node metastasis at RC. Routine pathologic evaluation of percent MP component has the potential to help select patients with MPUC that might be reasonable candidates for intravesical therapy.
引言/背景：微乳头型尿路上皮癌（MPUC）与膀胱内治疗失败风险增加相关，这可能是由于根治性膀胱切除术（RC）时隐匿性淋巴结（LN）转移风险增加所致。迄今为止，关于经尿道切除术（TUR）样本中MPUC所占百分比是否会影响RC时的LN阳性情况，相关数据有限。我们的目的是评估TUR上MP变异百分比与淋巴结转移发生率及生存结果之间的关联。
从2007年至2022年在我们机构接受RC的患者前瞻性维护数据库中，共识别出67例TUR上有MPUC的患者。TUR样本由一位有超过十年经验的泌尿生殖系统病理专家重新审查。评估MP成分的存在及百分比、淋巴管浸润（LVI）、原位癌（CIS）、分级和临床分期。从后续的RC标本中收集病理结果，并通过Kaplan-Meier方法估计无复发生存期（RFS）和总生存期（OS）。根据情况，使用单变量和多变量逻辑回归以及Cox生存分析评估MP百分比与淋巴结转移、RFS和OS之间的关联。
67例患者中有34例（51%）因cT1期疾病接受了RC，其余患者患有≥cT2期疾病。33例≥cT2期疾病患者中有19例（58%）接受了新辅助化疗（NAC）。cT1期患者的MPUC平均百分比为35%，cT2期患者为28%（P = 0.25）。单变量分析显示，MPUC≥30%（比值比（OR）3.38，P = 0.02）和临床≥T2期（OR 2.88，P = 0.04）都是RC时淋巴结转移的显著预测因素。多变量分析显示，MPUC%（OR 1.02，P = 0.036）或MPUC%≥30%（OR 4.01，P = 0.013）以及临床T分期≥2（OR 3.73，P = 0.018）是病理淋巴结阳性疾病的显著预测因素。cT1期疾病且MPUC<30%的患者淋巴结转移率最低（3/16，18.7%），而≥cT2期疾病且MP≥30%的患者淋巴结转移率最高（12/16，75%）。
TUR上MPUC成分的百分比与RC时隐匿性淋巴结转移风险增加相关。对MP成分百分比进行常规病理评估有可能帮助选择可能适合膀胱内治疗的MPUC患者。
