Histologic grading of urothelial carcinoma: a reappraisal
Histologic grading of urothelial carcinoma: a reappraisal
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DOI：
10.1016/j.humpath.2012.01.008
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发表时间：
2012-12-01
期刊：
影响因子：
3.3
通讯作者：
Lopez-Beltran, Antonio
中科院分区：
文献类型：
--
作者：
Cheng, Liang;MacLennan, Gregory T.;Lopez-Beltran, Antonio
膀胱癌的统一分级系统将允许不同中心之间的治疗结果的有效比较。世界卫生组织（2004）/国际泌尿病理学会分类的引入是朝着治疗和随访方案标准化迈出的可喜一步。与世界卫生组织（2004）1国际泌尿病理学会分类系统的最大争议来源集中在低度恶性潜力的乳头状尿路上皮肿瘤的诊断上。有些人认为乳头状尿路上皮肿瘤的低恶性潜能术语增加了组织学分级的复杂性，并不能准确反映生物学潜能。低恶性潜能的乳头状尿路上皮肿瘤是一种低度恶性的乳头状尿路上皮肿瘤，其复发和进展的发生率很高。在区分低度恶性潜能的乳头状尿路上皮肿瘤和非侵袭性低度恶性乳头状尿路上皮癌时，观察者之间存在相当大的差异。由于这些原因，一些研究者认为，低恶性潜能的乳头状尿路上皮肿瘤本质上是一种以前在世界卫生组织1973年分级系统中被指定为1级尿路上皮癌的实体。此外，低恶性潜能的乳头状尿路上皮肿瘤患者的治疗和随访方案通常与低级别、非浸润性尿路上皮癌患者的治疗和随访方案没有差异，这使得对低恶性潜能的乳头状尿路上皮肿瘤进行区分的临床需求最小化。我们建议在膀胱肿瘤分类中放弃“低度恶性潜能的乳头状尿路上皮肿瘤”这一术语。全基因组搜索作为癌症标志物的预后和预测性分子基因表达特征已显示出显著的前景。这些肿瘤的分子分级的最新进展可能最终取代传统的形态学分级系统，允许更精确和客观地评估肿瘤的生物学潜能。(C)2012 Elsevier Inc. All rights reserved.
A uniform grading system for bladder cancer will allow for valid comparison of treatment results among different centers. The introduction of the World Health Organization (2004)/International Society of Urological Pathology classification is a welcome step toward standardization of treatment and follow-up regimens. The greatest source of controversy with the World Health Organization (2004)1 International Society of Urological Pathology classification system centers on the diagnosis of papillary urothelial neoplasm of low malignant potential. Some feel that papillary urothelial neoplasm of low malignant potential terminology increases the complexity of histologic grading and does not accurately reflect biologic potential. Papillary urothelial neoplasm of low malignant potential is a low-grade papillary urothelial neoplasm with a substantial incidence of recurrence and progression. In the distinction of papillary urothelial neoplasm of low malignant potential from noninvasive low-grade papillary urothelial carcinoma, there is considerable interobserver variability. For these reasons, some investigators believe that papillary urothelial neoplasm of low malignant potential is, in essence, an entity that was previously designated grade 1 urothelial carcinoma in the World Health Organization 1973 grading system. In addition, treatment and follow-up regimens for patients with papillary urothelial neoplasm of low malignant potential do not typically differ from those prescribed for low-grade, noninvasive urothelial carcinoma, thriller minimizing the clinical need for the papillary urothelial neoplasm of low malignant potential distinction to be made. We propose abandonment of the terminology "papillary urothelial neoplasm of low malignant potential" in bladder tumor classification. Full-genome searches for prognostic and predictive molecular gene expression signatures as cancer markers have shown significant promise. Recent advances in the molecular grading of these tumors may eventually supplant traditional morphologic grading systems, allowing a more precise and objective assessment of the tumors' biologic potentials. (C) 2012 Elsevier Inc. All rights reserved.