Clinicopathological Analysis of Patients with Non-muscle-invasive Bladder Cancer: Prognostic Value and Clinical Reliability of the 2004 WHO Classification System
Clinicopathological Analysis of Patients with Non-muscle-invasive Bladder Cancer: Prognostic Value and Clinical Reliability of the 2004 WHO Classification System
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DOI：
10.1093/jjco/hyt120
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发表时间：
2013-11-01
影响因子：
2.4
通讯作者：
Tsukamoto, Taiji
中科院分区：
文献类型：
--
作者：
Nishiyama, Naotaka;Kitamura, Hiroshi;Tsukamoto, Taiji
目的：本研究的目的是阐明2004年世界卫生组织分类系统的非肌层浸润性膀胱癌的预后价值和临床可靠性。方法：1995年1月至2010年11月，153例患者被诊断为非肌层浸润性膀胱癌。结果：根据1973年世界卫生组织分级标准，膀胱移行细胞癌1-3级分别为2例（1.3%）、89例（58.2%）和62例（40.5%）。根据2004年世界卫生组织的分类系统，其中37个国家（24.2%）和116个国家（75.8%）被评为低和高。所有进展病例（15例患者）在初次经尿道膀胱肿瘤切除术时均被诊断为高级别。根据Kaplan-Meier分析，2004年世界卫生组织分类系统准确预测了肿瘤复发（P = 0.029）和进展（P = 0.031）。低级别和高级别肿瘤患者的5年无复发生存率分别为68.7%和47.1%，5年无进展生存率分别为100%和89.0%。在高级别T1病例中，（T1 m或T1 e）是肿瘤复发的重要预测因子（P = 0.001）和进展（P = 0.020）。2004年世界卫生组织的分类系统准确地预测了原发性非肌源性乳腺癌复发的风险，浸润性膀胱癌病例，并在预测进展风险时具有与1973年世界卫生组织分类相同的准确性。此外，高级别T1肿瘤的亚分期系统在预测复发和进展方面是有用的。
Objective: The aim of this study was to clarify the prognostic value and clinical reliability of the 2004 World Health Organization classification system of non-muscle-invasive bladder cancer.Methods: Between January 1995 and November 2010, 153 patients were diagnosed with non-muscle- invasive bladder cancer. We used a substage system that discerns T1-microinvasive (T1m, 42 patients) and T1-extensive-invasive (T1e, 37 patients) cancers.Results: There were 2 (1.3%), 89 (58.2%) and 62 (40.5%) cases of Grade 1-3 urothelial carcinoma, respectively, on the basis of the 1973 World Health Organization classification system. Of these, 37 (24.2%) and 116 (75.8%) were graded as low and high on the basis of the 2004 World Health Organization classification system. All of the cases with progression (15 patients) were diagnosed as high grade at the time of primary transurethral resection of the bladder tumor. Based on the Kaplan-Meier analysis, the 2004World Health Organization classification system accurately predicted tumor recurrence (P = 0.029) and progression (P = 0.031). The 5-year recurrence-free survival rates in patients with low-grade and high-grade tumors were 68.7 and 47.1%, and the 5-year progression-free survival rates were 100 and 89.0%, respectively. In the high-grade T1 cases, the substage (T1m or T1e) was a significant predictor of tumor recurrence (P = 0.001) and progression (P = 0.020).Conclusions: The 2004 World Health Organization classification system accurately predicts the risk of recurrence in primary non-muscle-invasive bladder cancer cases and has the same accuracy when predicting the risk of progression as the 1973 World Health Organization classification. Furthermore, the substaging system for high-grade T1 tumors is useful in predicting both recurrence and progression.