The influence of the level of lamina propria invasion and the prevalence of p53 nuclear accumulation on survival in stage T1 transitional cell bladder cancer
The influence of the level of lamina propria invasion and the prevalence of p53 nuclear accumulation on survival in stage T1 transitional cell bladder cancer
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DOI：
10.1016/s0022-5347(01)64021-7
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发表时间：
1998-01-01
影响因子：
6.6
通讯作者：
Steven, K
中科院分区：
文献类型：
--
作者：
Hermann, GG;Horn, T;Steven, K
目的：我们评估了固有层浸润的水平和P53核免疫反应的患病率对T1期膀胱移行细胞cancer.Materials和方法的患者的生存的影响：所有患者提出的T1期膀胱癌的前瞻性和常规分组根据固有层浸润的水平。肿瘤蒂浸润定义为T1 a期，固有层浸润至粘膜肌层水平浅表定义为T1 b期，浸润至粘膜肌层或深于粘膜肌层定义为T1 c期。结果：143例患者中T1 a期31例（22%），T1 b期60例（42%），T1 c期52例（36%）。患者平均年龄为67岁（范围38 - 92岁），平均随访时间为4.7年（范围2.4 - 9.7年）。与固有层浸润深度相关的肿瘤分级（p < 0.05）和随机粘膜活检中异型增生的患病率在T1 b和T1 c期肿瘤中高于T1 a期。42%的肿瘤表达p53核反应性，与肿瘤分级相关（p < 0.05）。此外，与T1 a疾病相比，T1 b和T1 c阶段的核p53患病率更高。115例行单纯电切术，28例行根治性膀胱切除术。总生存率为60.1%。年龄是75岁以上患者生存的唯一独立预测因素。对于75岁以下的患者，生存率与年龄、固有层浸润水平和p53核积聚的存在有关。该亚群的总生存率为67%，T1 a期为79%，T1 b期为70%，T1 c期为57%（p < 0.05）。p53阴性患者的生存率（73%）高于p53阳性患者（61%）（p < 0.05）。一个多变量分析固有层的入侵和核p53状态对生存组织学的影响被发现是唯一的独立预测survival.Conclusions：立即根治性膀胱癌应考虑为T1 C期肿瘤患者和T1 B期疾病的一些患者，特别是那些与肿瘤表达p53核反应性和异型增生的随机粘膜活检。
Purpose: We assessed the influence of the level of lamina propria invasion and the prevalence of p53 nuclear immunoreactivity on the survival of patients with stage T1 transitional cell bladder cancer.Materials and Methods: All patients presenting with stage T1 bladder cancer were prospectively and routinely grouped according to the level of lamina propria invasion. Invasion of the tumor stalk was defined as stage T1a, invasion of the lamina propria proper superficial to the level of muscularis mucosa as stage T1b and into or deeper than the muscularis mucosa as stage T1c. The p53 nuclear immunoreactivity was determined with antibody PAB 1801.Results: The study comprised 143 patients including 31 (22%) with stage T1a disease, 60 (42%) with stage T1b and 52 (36%) with stage T1c. Mean patient age was 67 years (range 38 to 92) and mean followup was 4.7 years (range 2.4 to 9.7). Tumor grade related to the depth of lamina propria invasion (p < 0.05) and the prevalence of dysplasia in random mucosal biopsies was higher in stage T1b and T1c tumors than in stage T1a. Of all tumors 42% expressed p53 nuclear reactivity which correlated with tumor grade (p < 0.05). Also the prevalence of nuclear p53 was higher in stages T1b and T1c compared with T1a disease. Of the patients 115 were treated with transurethral resection alone and 28 underwent radical cystectomy. Overall survival was 60.1%. Age was the only independent predictor of survival in patients older than 75 years. For patients up to 75 years old survival related to age, level of lamina propria invasion and presence of p53 nuclear accumulation. For this subpopulation overall survival was 67%, and 79% for stage T1a, 70% for stage T1b and 57% for stage T1c (p < 0.05). Survival was higher in patients with p53 negative (73%) than in those with p53 positive (61%) tumors (p < 0.05). A multivariate analysis of the influence of lamina propria invasion and nuclear p53 status on survival histology was found to be the only independent predictor of survival.Conclusions: Immediate radical cystectomy should be considered for patients with stage T1c tumors and for some patients with stage T1b disease, particularly those with tumors expressing p53 nuclear reactivity and with dysplasia in the random mucosal biopsies.