Tumor Budding: Prognostic Value in Muscle-invasive Bladder Cancer
Tumor Budding: Prognostic Value in Muscle-invasive Bladder Cancer
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DOI：
10.1016/j.urology.2019.04.006
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发表时间：
2019-08-01
期刊：
影响因子：
2.1
通讯作者：
Ramos Soler, David
中科院分区：
文献类型：
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作者：
Lorenzo Soriano, Laura;Ordaz Jurado, Guzman;Ramos Soler, David
目的探讨“肿瘤萌芽”（TB）是否为肌肉浸润性膀胱癌（MIBC）的不良预后因素。结核是指位于肿瘤侵袭前沿的分离的肿瘤细胞或小于5个细胞的小群体。材料与方法对106例接受根治性膀胱切除术的MIBC患者进行回顾性研究。采用细胞角蛋白AE1/AE3免疫染色法对TB进行“热点”鉴定和定量。评估的变量包括：年龄、性别、肿瘤、淋巴结、转移分类（TNM）分期、相关原位癌、分化程度、肿瘤大小、肿瘤位置、淋巴、静脉或神经周围浸润、p53、Ki67、分子亚型（基底/腔内）和化疗。主要变量为总生存率和癌症特异性生存率。结果平均随访时间为47±46.45个月。平均结核数为32.3±25.9“芽”。ROC曲线以14个“芽”为分界点：“低级别结核”组（14个“芽”）的中位生存率为18.5个月（P= 0.003）。在多变量分析中，死亡率的独立预测变量为：年龄、结核病和TNM分期。超过14个“芽”的患者死亡风险高出2.27倍，95%CI:1.19-4.34, P = 0.013。此外，随着“芽”数量的增加，死亡风险逐渐增加，每个“芽”的死亡率为2%。结论：根据我们的研究结果，结核病成为MIBC中癌症特异性死亡率的独立预测因素，其临界值为14个“芽”。(C) 2019 Elsevier Inc.
OBJETIVES To assess if "tumor budding" (TB) behaves as a poor prognostic factor in muscle-invasive bladder carcinoma (MIBC). TB is the presence of tumor cells isolated or in small groups of fewer than 5 cells located at the tumor invasion front.MATERIAL AND METHODS Retrospective study of 106 patients with MIBC who underwent radical cystectomy. A cytokeratin AE1/AE3 immunostaining was applied to identify and quantify TB by the "hot-spot" method. The variables evaluated were: age, gender, Tumour, Node, Metastasis Classification (TNM) stage, associated Carcinoma in situ, differentiation degree, tumor size, tumor location, lymphatic, venous or perineural invasion, p53, Ki67, molecular subtype (basal/luminal) and chemotherapy. Main variables were overall and cancer-specific survival.RESULTS The mean follow-up time was 47 +/- 46.45 months. The mean TB count was 32.3 +/- 25.9 "buds." The ROC curve established 14 "buds" as the cut-off point: the median survival rate for the "low-grade TB" group (14 "buds") was 18.5 months (P= .003). In the multivariate analysis, independent predictive variables regarding mortality were: age, TB, and TNM stage. Patients with more than 14 "buds" had 2.27 times more risk of mortality, 95%CI:1.19-4.34, P = .013. In addition, the risk of mortality rises progressively as the number of "buds" increases, at a rate of 2% per "bud."CONCLUSION According to our results, TB becomes an independent predictor factor for cancer-specific mortality in MIBC, with a cut-off point of 14 "buds." (C) 2019 Elsevier Inc.