Minato Akinori, Yoshii Moena, Watanabe Shuki, Moriya Ryosuke, Kashiwagi Eiji, Fujimoto Naohiro
Department of Urology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
Department of Urology, Kitakyushu City Yahata Hospital, Kitakyushu, Japan.
Jpn J Clin Oncol. 2025 Apr 6;55(4):414-420. doi: 10.1093/jjco/hyae183.
This study aimed to assess the oncological outcomes of the subtype of urothelial carcinoma (SUC), including divergent differentiation and histologic subtype, in comparison with those of pure urothelial carcinoma (PUC) in nonmuscle-invasive bladder cancer.
We retrospectively evaluated patients who were initially treated with transurethral resection of the bladder tumor (TURBT) between March 2005 and August 2020 at a single institution. Patients with PUC and SUC were compared in terms of recurrence-free survival (RFS), progression-free survival (PFS), and overall survival (OS).
Out of 853 enrolled patients, 783 (91.8%) and 70 (8.2%) had PUC and SUC, respectively. SUC presence was significantly associated with old age, tumor size (≥3 cm), higher pT1 rate, high grade, concomitant carcinoma in situ, and lymphovascular invasion. RFS rates after TURBT did not significantly differ between the PUC and SUC groups. With a median follow-up period of 66 months (interquartile range, 38-103 months), the rates and median time of progression to muscle invasion were 6.9% and 22.5 months in the PUC group, and 22.9% and 10.0 months in the SUC group. Moreover, the incidence of progression to metastasis was 4.6% and 15.7% in the PUC and SUC groups, respectively. The 5-year PFS rates (64.5% and 81.9%, P < .001) and 5-year OS rates (71.7% and 86.2%, P = .009) were lower in the SUC group than in the PUC group. On multivariate analysis, SUC presence independently predicted progression to muscle invasion and metastasis.
At initial TURBT diagnosis, we must pay more attention to higher progression risk of SUC than that of PUC in nonmuscle-invasive bladder cancer.
本研究旨在评估非肌层浸润性膀胱癌中尿路上皮癌亚型（SUC）的肿瘤学结局，包括分化差异和组织学亚型，并与纯尿路上皮癌（PUC）进行比较。
我们回顾性评估了2005年3月至2020年8月期间在单一机构最初接受经尿道膀胱肿瘤切除术（TURBT）治疗的患者。比较了PUC和SUC患者的无复发生存率（RFS）、无进展生存率（PFS）和总生存率（OS）。
在853名入组患者中，分别有783例（91.8%）和70例（8.2%）患有PUC和SUC。SUC的存在与老年、肿瘤大小（≥3 cm）、较高的pT1率、高级别、原位癌并存以及淋巴管浸润显著相关。TURBT后的RFS率在PUC组和SUC组之间无显著差异。中位随访期为66个月（四分位间距，38 - 103个月），PUC组进展为肌层浸润的发生率和中位时间分别为6.9%和22.5个月，SUC组分别为22.9%和10.0个月。此外，PUC组和SUC组进展为转移的发生率分别为4.6%和15.7%。SUC组的5年PFS率（64.5%和81.9%，P <.001）和5年OS率（71.7%和86.2%，P =.009）低于PUC组。多因素分析显示，SUC的存在独立预测进展为肌层浸润和转移。
在初次TURBT诊断时，我们必须更加关注非肌层浸润性膀胱癌中SUC比PUC更高的进展风险。
