非肌层浸润性混合级膀胱尿路上皮癌组织学特点及预后分析

Characteristics and clinical significance of mixed grade nonmuscle invasive urothelial carcinoma of urinary bladder

目的尽管大部分尿路上皮癌的病理结果表现为单纯的低或高级别类型,但是临床上仍有部分肿瘤表现为高低级别混合型尿路上皮癌。非肌层浸润性混合级别膀胱尿路上皮癌(bladder urothelial carcinoma,BUC)的组织学特点与预后的关系仍不明确。本研究分析非肌层浸润性混合级别BUC组织学构成特点,探讨肿瘤的异质性与患者预后的关系,为更好地了解BUC组织成分的异质性提供理论依据。方法回顾性分析2003-01-07-2015-12-26大连医科大学附属大连市友谊医院437例因非肌层浸润性BUC行经尿道膀胱肿瘤电切术后卡介苗灌注治疗患者的病例资料。选取33例高级别BUC患者作为对照(低级别BUC患者作为阴性对照),判断混合级别BUC组织学构成与临床特点的关系。结果混合级别BUC中低级别成分为主要成分,高级别成分<10%。混合级别组5年肿瘤无进展生存率为93.94%,明显低于高级别组的69.91%,P=0.008;但是与低级别组相似,P=0.087。混合级别组(93.94%)与高级别组(79.65%)5年疾病特异性生存率差异有统计学意义,P<0.001;而与低级别组相似,P=0.152。5年无复发生存率差异无统计学意义,P=0.217。结论高低级别混合性BUC具有独特的临床特点,对BUC临床病理学分级具有良好的指导意义。

OBJECTIVE Although most of the pathological urothelial carcinoma show pure low grade（LG）or high grade（HG）histology,but there are still some clinical features of tumors of high and low grade mixed（MG）urothelial carcinoma.The relationship between pathological feature and prognosis of MG tumors in patients with non muscle invasive urothelial carcinoma is not clear.This study aimed to analyze non muscle invasive bladder urothelial carcinoma（BUC）mixed level histological characteristics and to explore the relationship between tumor heterogeneity and the prognosis of patients,in order to understand the heterogeneity of BUC and provide a theoretical basis for the composition.METHODS The clinical data of 437 cases with a mean age of 66.3 years underwent transurethral resection（TURBT）of nonmuscle invasive bladder tumors by intravesical Bacillus Calmette-Guérin（BCG）therapy were analyzed retrospectivly.There were 341 males and 96 females.We selected 33 cases of high grade bladder cancer patients as control,and determined relationship between the mixture grade bladder cancer histological structure and clinical characteristics.RESULTS The specimen with MG BUC showed less than 10% HG element.Five-year progression-free survival in patients with high grade tumors was obviously lower to mixed grade（69.91%vs 93.94%,P=0.008）,but similar to low grade（P=0.087）.Five-year disease specific survival was significantly lower for high grade tumors（79.65%vs 93.94%,P〈0.001）,but similar to low grade（P=0.152）.CONCLUSION Mixed high and low grade BUC represents unique clinical characteristics,the clinical pathology classification of bladder cancer has a good guiding significance.