Noninvasive Papillary Urothelial Carcinoma of the Bladder: An Institutional Experience Focusing on Tumors With Borderline Features.

IF 3.7 3区医学 Q2 MEDICAL LABORATORY TECHNOLOGY

Archives of pathology & laboratory medicine Pub Date : 2024-02-01 DOI:10.5858/arpa.2022-0268-OA

Jennifer M Oliver-Krasinski, Samuel Bidot, Justin W Ingram, Kathleen M O'Toole, James M McKiernan, Mazie Tinsley, Lara R Harik

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引用次数: 0

Abstract

Context.—: Noninvasive papillary urothelial carcinomas (PUCs) comprise most urinary bladder tumors. Distinction between low-grade (LG-PUC) and high-grade (HG-PUC) PUCs is pivotal for determining prognosis and subsequent treatment.

Objective.—: To investigate the histologic characteristics of tumors with borderline features between LG-PUC and HG-PUC, focusing on the risk of recurrence and progression.

Design.—: We reviewed the clinicopathologic parameters of noninvasive PUC. Tumors with borderline features were subcategorized as follows: tumors that look like LG-PUC but have occasional pleomorphic nuclei (1-BORD-NUP) or elevated mitotic count (2-BORD-MIT), and tumors with side-by-side distinct LG-PUC and less than 50% HG-PUC (3-BORD-MIXED). Recurrence-free, total progression-free, and specific invasion-free survival curves were derived from the Kaplan-Meier method, and Cox regression analysis was performed.

Results.—: A total of 138 patients with noninvasive PUC were included, with the following distribution: LG-PUC (n = 52; 38%), HG-PUC (n = 34; 25%), BORD-NUP (n = 21; 15%), BORD-MIT (n = 14; 10%), and BORD-MIXED (n = 17; 12%). Median (interquartile range) follow-up was 44.2 months (29.9-73.1 months). Invasion-free survival was different between the 5 groups (P = .004), and pairwise comparison showed that HG-PUC had a worse prognosis compared with LG-PUC (P ≤ .001). On univariate Cox analysis, HG-PUC and BORD-NUP were 10.5 times (95% CI, 2.3-48.3; P = .003) and 5.9 times (95% CI, 1.1-31.9; P = .04) more likely to invade, respectively, when compared to LG-PUC.

Conclusions.—: Our findings confirm a continuous spectrum of histologic changes in PUC. Approximately a third of noninvasive PUCs show borderline features between LG-PUC and HG-PUC. Compared with LG-PUC, BORD-NUP and HG-PUC were more likely to invade on follow-up. BORD-MIXED tumors did not statistically behave differently from LG-PUC.

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非侵袭性膀胱乳头状上皮癌：以具有边界特征的肿瘤为重点的机构经验。

背景非侵袭性乳头状尿路上皮癌（PUC）是大多数膀胱肿瘤的组成部分。区分低级别（LG-PUC）和高级别（HG-PUC）PUC对于确定预后和后续治疗至关重要：研究具有LG-PUC和HG-PUC交界特征的肿瘤的组织学特征，重点关注复发和进展的风险：我们回顾了非侵袭性PUC的临床病理学参数。具有边界特征的肿瘤被细分为以下几类：看起来像LG-PUC但偶尔有多形性核（1-BORD-NUP）或有丝分裂计数增高（2-BORD-MIT）的肿瘤，以及LG-PUC和HG-PUC并列且少于50%的肿瘤（3-BORD-MIXED）。无复发、总无进展和无特异性浸润生存曲线由 Kaplan-Meier 法得出，并进行了 Cox 回归分析：共纳入138名非侵袭性PUC患者，分布情况如下：LG-PUC（n=52；38%）、HG-PUC（n=34；25%）、BORD-NUP（n=21；15%）、BORD-MIT（n=14；10%）和BORD-MIXED（n=17；12%）。随访中位数（四分位间范围）为 44.2 个月（29.9-73.1 个月）。5 组患者的无侵袭生存期存在差异（P = .004），配对比较显示，HG-PUC 的预后比 LG-PUC 差（P ≤ .001）。在单变量Cox分析中，与LG-PUC相比，HG-PUC和BORD-NUP的侵袭几率分别是LG-PUC的10.5倍（95% CI，2.3-48.3；P = .003）和5.9倍（95% CI，1.1-31.9；P = .04）：我们的研究结果证实了PUC组织学变化的连续性。大约三分之一的非浸润性PUC显示出LG-PUC和HG-PUC之间的边缘特征。与LG-PUC相比，BORD-NUP和HG-PUC在随访时更容易发生浸润。在统计学上，BORD-MIXED肿瘤与LG-PUC的表现并无不同。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Archives of pathology & laboratory medicine 医学-病理学

CiteScore

9.20

自引率

2.20%

发文量

369

审稿时长

3-8 weeks

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