Carcinoma of the Bladder: Predictors
Carcinoma of the Bladder: Predictors
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膀胱癌：预测因素
DOI：
10.1002/cncr.1980.45.s7.1849
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发表时间：
1980
期刊：
影响因子：
6.2
通讯作者：
K. Cummings
中科院分区：
文献类型：
--
作者：
K. Cummings
膀胱癌的自然病程是不可预测的。在一些患者中，侵袭性（潜在致命性）癌代表其最初的临床表现，而在其他患者中，以多个复发性肿瘤为特征的长期临床过程被证实。后一种患者人群是最令泌尿科医生烦恼的。对患者肿瘤的“风险状态”的预测历来是基于采用等级和分期的临床病理分期。侵袭性（潜在致死性）癌发展的预测性临床证据已从观察肿瘤复发的速度和模式（单个与多个）、肿瘤特征（级别、形状和淋巴或静脉浸润的存在）以及在预先选择的内窥镜正常活检部位原位癌的存在中收集。目前可用的“客观”预测因子，如浸润性膀胱癌患者膀胱尿道炎的血型同种抗原缺失是挑衅性的。目前，这项技术还不能精确地确定特定患者何时会发生肿瘤侵袭。然而，这种方法在前瞻性研究中的应用（包括预先选择的内窥镜检查正常粘膜活检）以及切除的肿瘤组织可能被证明是有价值的。在用电子显微镜和免疫荧光探针研究的超微结构水平上，质膜的改变已被定义为与恶性转化和异常生长模式（可能预测肿瘤侵袭）相关。这些技术中的某些技术适当地应用于高危人群，最终可能有助于外科医生选择摘除手术的时机。
The natural history of carcinoma of the bladder is unpredictable. In some patients, invasive (potentially lethal) carcinomas represent their initial clinical presentation, whereas in others, a protracted clinical course characterized by multiple recurrent tumors is witnessed. This latter population of patients is the most vexing to the urologist. The prediction of the patient's “state of risk” from the tumor has historically been based on clinical pathologic staging employing grade and stage. Predictive clinical evidence for the development of invasive (potentially lethal) carcinoma has been gleaned from observations of the rapidity and pattern of tumor recurrence (single vs. multiple), tumor characteristics (grade, shape, and presence of lymphatic or venous invasion) and the presence of carcinoma in situ at preselected endoscopically normal biopsy sites. Currently available “objective” predictors such as blood group isoantigen deletion from bladder urothelium of patients with invasive bladder carcinoma are provocative. Presently, this technique cannot pinpoint when tumor invasion will occur in a particular patient. However, the application of this methodology in a prospective study (including examination of preselected endoscopically normal mucosal biopsies) is well as resected tumor tissue may prove valuable. At the ultrastructure level as studied with the electron microscope and immunofluorescent probes, alterations in the plasma membrane have been defined that are associated with malignant transformation and abnormal growth patterns (potentially predictive of tumor invasion). Certain Of these techniques appropriately applied to a population at high risk may ultimately assist the surgeon in timing extirpative surgery.