- Human Pathology（Youssef、Acosta 等，印第安纳大学牵头多机构）：206 例新辅助化疗（NAC）后根治性膀胱切除，按 NAC 前肌层浸润 TURBT 有无非经典成分（UC-NCC，即分化性改变或组织学亚型）分组。
- 经典 UC 92 例；含 1 种 UC-NCC 73 例、2 种 30 例、3 种及以上 11 例。
- 有 UC-NCC 者病理完全缓解（p=0.021）和降期（p=0.027）更少，切缘阳性率无差异；UC-NCC 的数量与降期或完全缓解无关。
- 报告提示：TURBT 中任何非经典成分都值得写明，提示 NAC 后病理反应可能较差。本站仅获摘要。
收录范围：PubMed 摘要中英对照。原文为 Elsevier 订阅内容，本站未获全文与图表。
摘要
背景
在尿路上皮癌（UC）中，多种形式的分化性改变（divergent differentiation）或组织学亚型（以下统称为伴非经典成分的 UC [UC-NCC]）与典型 UC 相比，会对疾病特异性临床结局产生不利影响。既往研究提示，UC-NCC 对新辅助化疗（NAC）的反应率可能较低，这在一定程度上可解释其更具侵袭性的病程。然而，关于 NAC 后根治性膀胱切除（RC）病理结局的数据相互矛盾，UC-NCC 的成分数量对 NAC 反应的影响也尚不清楚。本研究在考虑单个病例中 UC-NCC 成分数量的前提下，评估了 UC-NCC 对 NAC 后 RC 结局的影响。
方法
检索各参与机构病理数据库中的 NAC 后 RC 病例，选取既往经尿道切除（TURBT）病理结果可查者纳入研究。根据 NAC 前显示肌层浸润癌的 TURBT 中有无 UC-NCC 进行分组；有 UC-NCC 者再按所含 UC-NCC 数量（1 种、2 种、3 种及以上）分层。在 RC 标本上评估以下病理结局：病理降期（<ypT2 ypN0）、完全缓解（ypT0/Tis/Ta ypN0）、肿瘤退缩的组织学评估及切缘状态。
结果
该多机构队列共 206 例患者：经典 UC 92 例，含 1 种 UC-NCC 73 例，含 2 种 30 例，含 3 种及以上 11 例。存在 UC-NCC 与较低的病理完全缓解率（p=0.021）和降期率（p=0.027）相关，手术切缘阳性率无显著差异。UC-NCC 的数量与病理降期或完全缓解无相关性。
结论
存在 UC-NCC 与 NAC 及 RC 后不良病理结局相关。
- Human Pathology (Youssef, Acosta and colleagues, multi-institutional, led from Indiana University): 206 post-NAC radical cystectomies, grouped by non-conventional components (UC-NCC: divergent differentiation or histologic subtypes) in the pre-NAC muscle-invasive TURBT.
- Conventional UC 92; 1 UC-NCC 73; 2 UC-NCC 30; 3 or more 11.
- UC-NCC was associated with lower complete pathologic response (p=0.021) and downstaging (p=0.027), without a difference in positive margins; the number of components did not correlate with response.
- Reporting point: any non-conventional component in a TURBT is worth recording, as it predicts poorer pathologic response to NAC. Abstract only.
Scope: the PubMed abstract. The article is Elsevier subscription content; the full text and figures were not obtained.
Abstract
Background
In urothelial carcinoma (UC), the presence of many form of divergent differentiation or histologic subtypes (henceforth collectively designated as UC with non-conventional components [UC-NCC]) negatively influences disease-specific clinical outcomes when compared to typical UC. Prior studies have suggested that UC-NCC may show lower rates of response to neoadjuvant chemotherapy (NAC), a factor that may partially explain their more aggressive course. However, data on post-NAC pathology outcomes in radical cystectomy (RC) are conflicting, and the influence of the number of UC-NCC on NAC response remains unknown. In this study, we evaluated the impact of UC-NCC on post-NAC RC outcomes, accounting for the number of UC-NCC components present within individual cases.
Methods
The pathology databases of the participating institutions were queried for post-NAC RCs. Those with pathology results available from the prior transurethral resection (TURBT) were selected for inclusion in the study. Cases were separated according to the presence or absence of UC-NCC in a pre-NAC TURBT showing muscle-invasive cancer. Those with UC-NCC were further stratified according to the number of UC-NCC present (1 versus 2 versus 3 or more). The following pathology outcomes were assessed on RCs: pathologic downstaging (<ypT2 ypN0), complete response (ypT0/Tis/Ta ypN0), histologic assessment of tumor regression, and margin status.
Results
This multi-institutional cohort consisted of 206 patients: 92 with conventional UC, 73 with 1 UC-NCC, 30 with 2 UC-NCC, and 11 with 3 or more UC-NCC. The presence of UC-NCC was associated with lower rates of complete pathologic response (p=0.021) and downstaging (p=0.027), without significant differences in the rate of positive surgical margins. There was no correlation between the number of UC-NCCs and pathologic downstaging or complete response.
Conclusions
The presence of UC-NCC is associated with adverse pathologic outcomes following NAC and RC.