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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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

期刊介绍： Welcome to the website of the Archives of Pathology & Laboratory Medicine (APLM). This monthly, peer-reviewed journal of the College of American Pathologists offers global reach and highest measured readership among pathology journals. Published since 1926, ARCHIVES was voted in 2009 the only pathology journal among the top 100 most influential journals of the past 100 years by the BioMedical and Life Sciences Division of the Special Libraries Association. Online access to the full-text and PDF files of APLM articles is free.