淋巴血管侵犯在T1期膀胱尿路上皮癌伴鳞状分化中的意义

Significance of lymphovascular invasion in pT1 squamous differentiated bladder urothelial carcinoma

目的系统评估淋巴血管侵犯(LVI)与伴有鳞状分化的T1期膀胱尿路上皮癌的病理特征及预后的相关性.方法回顾性分析105例确诊为T1期尿路上皮癌伴鳞状分化且接受经尿道膀胱肿瘤电切手术(TURBT)的患者临床与病理资料.采用苏木精-伊红染色和免疫组化染色确定肿瘤组织中LVI的存在.将所有患者按LVI,分为阴性组和阳性组,分析LVI与临床病理特征及5年肿瘤特异性生存率(CSS)的关系.将复发患者按复发后治疗方式,分为TURBT组和根治性膀胱切除术(RC)组,比较手术方式对CSS的影响.结果在105例患者中,有57例(27.6%)出现LVI.在LVI阴性的患者中,其5年CSS为84.9%;而LVI阳性患者为58.4%,差异有统计学意义(P<0.05).单因素分析结果表明,肿瘤多发情况、肿瘤大小、复发及LVI与CSS具有显著相关性(均P<0.05).多因素分析结果表明,肿瘤大小和LVI对CSS的影响显著(均P<0.05).在LVI阳性的复发患者中,行RC较TURBT有更高的CSS(P=0.042);而对于LVI阴性患者,两种方法的差异无统计学意义(P=0.692).结论伴鳞状分化的T1期膀胱尿路上皮癌中LVI是一种重要的预后因子,LVI和肿瘤≥3cm的患者具有更高的死亡风险.T1期膀胱癌伴鳞状分化尤其是合并LVI的患者应尽早行RC治疗.

Objective To systematically evaluate the prognostic significance of lymphovascular invasion (LVI) in pT1 stage bladder urothelial carcinoma with squamous differentiation. Methods The clinical and patholog- ical data of 105 patients with pT1 stage urothelial carcinoma with squamous differentiation and transurethral resec- tion of bladder tumor (TURBT) were retrospectively analyzed. Hematoxylin-eosin staining and immunohistochemical staining were used to determine the presence of LVI in tumor tissues. All patients were divided into LVI-negative group and LVI-positive group according to LVI. The relationship between LVI and clinicopathological features and 5- year cancer-specific survival (CSS) rate was analyzed. Patients with relapse were divided into TURBT group and radi- cal cystectomy (RC) group according to the surgical method,and the effects of the methods on CSS were compared. Results There are 57 patients (27.6%) had LVI. In the LVI-negative group,the 5-year CSS was 84.9%,while that in the LVI-positive group was 58.4%,the difference was statistically significant(P<0.05). Univariate analysis showed that tumor multiple appearance,tumor size,recurrence and LVI were significantly correlated with CSS (all P<0.05). Multivariate analysis showed that tumor size and LVI had significant effects on CSS (all P<0.05). In the relapsed pa- tients with LVI-positive,RC had a higher CSS than TURBT (P=0.042). In the relapsed patients with LVI-negative,the difference between the two methods was not statistically significant(P=0.692). Conclusions LVI is an important prognostic factor in pT1 stage urothelial carcinoma with squamous differentiation. Patients with LVI and tumor size > 3 cm have a higher risk of death. Patients with pT1 stage urothelial carcinoma with squamous differentiation,espe- cially those with LVI,should be treated with RC as soon as possible.