Should pT1 transitional cell cancers of the bladder still be classified as superficial?

Of 171 patients consecutively presenting with newly diagnosed transitional cell cancer (TCC) of the bladder, 107 were "superficial"; 98 have been followed up for 2 years and 84 for 3 years. No patient with pTa TCC developed muscle infiltrating recurrences, although 15% progressed to pT1 category by 3 years. At 2 and 3 years respectively, 33 and 46% of the pT1 TCC had progressed to infiltrate muscle. The use of the term "superficial" to describe pTa and pT1 category TCC together in one grouping should be reconsidered.     

pT1a期肾癌的预后因素分析

目的 通过术中及术后病理学相关因素对pT1a期肾癌患者进行预后分析。方法对2002年1月至2007年12月期间的168例pT1a期肾癌患者进行分析。所有患者均行单一肾癌根治术或肾部分切除术。对术前一般资料、随访时间、手术方式、病理学参数（肿瘤体积、肿瘤位置、病理类型等）进行回顾性分析。结果 患者平均年龄为（61.8±10.4）岁,平均随访时间为（29.9±11.2）个月,5年肿瘤特异生存率及5年无复发生存率分别为100%和88.1%。15例患者存在远处转移,但未发现局部复发。在单因素分析中,肿瘤坏死、微血管浸润及Fuhrman′s核分级对远处转移有显著影响。多因素分析表明肿瘤坏死及微血管浸润为独立的预后因素。结论 微血管浸润及肿瘤坏死为pT1a期肾癌患者的预后因素。     

pT1期肺腺癌淋巴结转移危险因素分析

目的探讨pT_1期肺腺癌发生淋巴结转移的危险因素。方法选择术后病理为T1期肺腺癌患者344例,记录患者术后病理资料和病历信息,将其分为淋巴结转移组与非转移组。数据进行单因素及多因素的统计学分析。结果 pT_1期肺癌淋巴结转移占19.2%,与性别、肿瘤大小、分化程度有关(P0.05)。结论根据患者的临床特征预测淋巴结转移的发生,指导手术中淋巴结的清扫以改善患者预后。     

Prognostic relevance of p53 and bcl-2 immunoreactivity for early invasive pT1/pT2 gastric carcinomas: indicators for limited gastric resections?

Background Laparoscopic or endoscopic limited resection is intended to be an additional therapeutic option for the treatment of early gastric cancer. However, tumorbiologic markers to predict the outcome for patients after limited resections are missing. This study therefore investigated the prognostic relevance of p53 and bcl-2 immunoreactivity as well as the percentage of apoptotic tumor cells in early invasive pT1/pT2 tumors managed with standard operations for gastric adenocarcinoma. Methods Histologic slides of 65 pT1/pT2 gastric carcinomas were investigated for bcl-2 and p53 immunoreactivity. For 35 patients, DNA fragmentation of tumor cell nuclei was determined by the terminal uridine 5′-triphosphate (UTP) nick end-labeling (TUNEL) method. Follow-up evaluation of the patients was prospectively documented for 53.4 ± 4.1 months. Results Findings showed that bcl-2 immunoreactivity was associated with tumors of the intestinal type according to Lauren′s classification (p = 0.042), and that p53 immunoreactivity was increased in more invasive tumors (pT1 vs pT2 tumors; p = 0.047). Mean survival time was significantly longer for patients with bcl-2-negative tumors (74.3 ± 6.8 months) than for patients with bcl-2-positive tumors (50.8 ± 7.6 months; p = 0.024). The percentage of apoptotic tumor cell nuclei did not have prognostic relevance in the population studied and was not associated with several histopathologic parameters or bcl-2 and p53 immunoreactivity. Subgroup analysis indicated that the survival of patients with differentiated G2 and bcl-2-negative/p53-negative tumors was significantly longer (82 ± 6 months) than the survival of patients with G2 bcl-2- and/or p53-positive tumors (41.8 ± 12.5 months; p = 0.005), with independent prognostic relevance determined by multivariate analysis (p = 0.024). Conclusion The data reported indicate that the analysis of bcl-2 and p53 immunoreactivity seems to have prognostic implications for early invasive (pT1/pT2) gastric adenocarcinomas and may subclassify patients for minimally invasive laparoscopic or endoscopic gastric resections.     

The pT1a and pT1b category subdivision in renal cell carcinoma: is it reflected by differences in tumour biology?

OBJECTIVE: To assess systematically the possible differences in pathology between pT1a and pT1b renal cell carcinomas (RCCs), as the sixth edition of the Tumour-Nodes-Metastasis (TNM) system implemented a subdivision of category pT1 into pT1a (<4 cm) and pT1b (4-7 cm), based on clinical outcome analysis and the approach to therapy. PATIENTS AND METHODS: Conventional histopathology and immunohistochemical expression of several biomarkers were analysed in 66 patients with pT1a and 29 with pT1b RCCs, using a tissue microarray technique. RESULTS: After 2 years of follow-up, none of the 66 patients with pT1a and three of the 29 with pT1b tumours developed progressive disease. The tumour was grade 3 in four (6%) pT1a and 11 (38%) pT1b RCCs. Immunohistochemically, pT1a RCCs were characterized by strong expression of p27 (79%), bcl-2 (67%), MUC1 (87%), insulin-like growth factor (IGF)-I (71%) and CD10 (88%), as well as moderate expression of IGF-I receptor (43%) and low expression of epidermal growth factor receptor (EGFR, 20%). During progression to category pT1b, expression of p27 significantly decreased (54%) and EGFR expression increased (38%). Moreover, membranous staining patterns of MUC1 and CD10 changed from apical to circumferential in clear cell RCCs. p53 (pT1a 23%, pT1b 28%), E-cadherin (10% and 17%), MIB-1 (1.2% and 1.5%) and Skp2 (2% and none) expression seemed to be of minor importance. CONCLUSION: This is the first study to show that the subdivision of category pT1 implemented in the latest issue of the TNM system is reflected by differences in conventional histopathology and expression of biomarkers.     

Hepatic resection in 485 R0 pT2 and pT3 cases of advanced carcinoma of the gallbladder: results of a Japanese Society of Biliary Surgery survey—a multicenter study

Purpose  We conducted this study to evaluate the optimal hepatic resection for pT2 and pT3 advanced carcinoma of the gallbladder without invasion of the hepatoduodenal ligament. Methods  We conducted a questionnaire survey regarding 4,243 cases of carcinoma of the gallbladder treated during the recent 10-year period at 112 institutions belonging to the Japanese Society of Biliary Surgery. The questionnaires included questions on preoperative-diagnosis, complications, treatment, and surgical treatment, procedures of resection, surgical result, path histological findings, mode, and site of recurrence, additional post-operative treatment. They included 293 pT2 and 192 pT3 R0 cases, which were negative for hepatoduodenal ligament invasion, and the cumulative survival rates and sites of postoperative recurrence in the form of liver metastasis, were retrospectively analyzed in these 485 cases. Result  There were no significant differences in survival rate or recurrence rates in the form of liver metastasis between the groups that underwent resection of the gallbladder bed, the group that underwent segmentectomy 4a+5, and the group that underwent hepatectomy in patients with of both pT2 or pT3 gallbladder cancers. Our results also did not show that liver metastasis to segment 4a5 alone was particularly common. Conclusion  For gallbladder cancer, neither with hepatoduodenal ligament invasion nor hepatic invasion, resection of the gallbladder bed is more preferable for surgical hepatic procedure. For gallbladder cancer that invades any hepatic sites, a hepatic surgical procedure that could eliminate surgical margins would be desirable.     

pT1N1M0胃癌患者辅助化疗适宜人群的研究

目的:探讨辅助化疗是否对所有pT1N1M0(ⅠB期)的胃癌患者有生存获益。方法:回顾性分析2010年1月至2016年12月在河南省肿瘤医院经手术切除并经病理学证实的185例pT1N1M0胃癌患者的临床资料,根据是否进行辅助化疗分为化疗组( n＝100)和非化疗组( n＝85)。 结果:...     

pT1期膀胱尿路上皮癌亚分期的研究进展及其临床意义

pT1期膀胱尿路上皮癌临床上易出现复发和恶性进展,其治疗方式也一直存在争议,pT1期膀胱尿路上皮癌亚分期的研究对pT1期膀胱肿瘤的处理策略具有重要的意义及临床应用价值.准确、通用的亚分期可以帮助我们有针对性的选择不同治疗方案,同时还可以准确预测患者预后以及肿瘤进展风险.     

Can pT0 stage of prostate cancer be predicted before radical prostatectomy?

OBJECTIVES: To report our experience with biopsy-proven pT0 prostate cancer over the last 10 yr. METHODS: We retrospectively analysed a series of 1950 consecutive patients treated with radical prostatectomy (RP) for clinically localized prostate cancer between 1996 and 2005 at our institution. The patients without residual tumour on RP specimen were defined as pT0 patients. The group of pT0 patients was compared with a control group of 295 patients operated consecutively during the same period. RESULTS: Overall, 11 (0.5%) patients were classified as pT0 on pathologic examination of the RP specimen. There was no pT0 tumour in the control group. Among the pT0 patients, five characteristics were particularly frequent: T1c clinical stage (90.9%), prostate-specific antigen (PSA) or=60 g (100%). All these characteristics were present in 8 of the 11 (72.7%) pT0 patients, while they were present in only 12 of the 295 (4.1%) controls. These parameters, when combined together, had a sensitivity of 72%, a specificity of 96%, and an accuracy of 99% for the prediction of pT0 stage. With a mean follow-up of 30 months after RP, no pT0 patient had clinical or biologic evidence of prostate cancer. CONCLUSIONS: In our experience, the rate of pT0 tumours after RP is 0.5%. The combination of clinical stage, preoperative PSA, number of positive biopsy cores, Gleason score, and prostate weight could help to predict pT0 stage after RP.     

pT1、G3膀胱癌采用保守还是手术治疗？

2004年德国泌尿外科会议Stoeckle等报道即时根治性膀胱切除术（RCE）存活率明显优于复发后RCE，分别为89％和60％。单纯TUR肿瘤复发率达80％，进展率48％。多数研究确定BCG减少肿瘤复发和进展。Patard等应用膀胱内灌注BCG治疗80例，随访〉60个月，明显减少了复发（Odds比率=0．475）和进展（Odds比率=0．444）的危险。     

pT1胸段食管鳞癌根治术后复发转移的危险因素分析

目的分析pT 1胸段食管鳞状细胞癌(thoracic esophageal squamous cell carcinoma)患者术后疗效及复发转移的危险因素,探讨pT 1食管癌术后的治疗方案。方法收集131例pT 1胸段食管鳞状细胞癌患者的病理和临床资料。采用SPSS 21. 0统计学软件进行统计分析。结果截止2018年1月,共有34例(25. 95%)患者死亡,27例死于肿瘤本身,另外有7例死于其他原因。随访期间出现28例(21. 4%)局部复发和(或)远处转移,其中局部-区域性复发15例(11. 45%),远处转移9例(6. 87%),出现局部区域性复发合并远处转移4例(3. 05%)。全组患者的1、3、5年的总生存时间(OS)率和无进展生存率(PFS)分别为96. 9%和90. 8%、86. 3%和80. 2%、71. 0%和69. 5%。单因素分析显示淋巴结转移、脉管瘤栓、浸润深度和嗜酒史是pT 1食管癌根治术后患者出现复发转移的独立危险因素(P 0. 05);多因素分析发现脉管瘤栓和嗜酒史是本组pT 1食管鳞癌患者术后出现局部复发和(或)远处转移的独立危险因素(P 0. 05)。Kaplan-Meier法分析提示淋巴结转移、脉管瘤栓、嗜酒史、肿瘤长度 2. 0 cm为术后PFS和OS的独立危险因素(P 0. 05);多因素COX回归分析提示脉管瘤栓、肿瘤长度 2. 0 cm、肿瘤低分化程度、嗜酒史是pT 1食管鳞癌术后影响PFS和OS的独立危险因素(P 0. 05);肿瘤长度和嗜酒史是pT 1N0食管鳞癌术后PFS和OS的独立危险因素。结论在pT 1期胸段食管鳞癌根治术后仍有21. 4%患者出现局部复发和(或)远处转移,浸润深度、肿瘤长度、淋巴结转移、肿瘤分化程度、脉管瘤栓及嗜酒史是影响其治疗效果的危险因素。这部分患者术后应该制定更加密集的随访策略,而适当的术后辅助治疗或有助于降低术后复发转移风险及改善预后。     

pT1～3N0期胃癌淋巴结微转移检测的临床意义

目的 研究淋巴结微转移及临床病理因素对pT1～3N0期胃癌患者术后5年无瘤生存率的影响.方法 纳入我院2000年1月至2004年12月期间pT1～3N0期胃癌患者行根治术者120例2 106枚淋巴结,每例患者淋巴结9～28枚,平均18枚,所有淋巴结经HE染色均为阴性.应用免疫组化染色法检测淋巴结中CK20表达,并分析胃癌患者的临床病理特征及胃癌淋巴结中CK20表达对5年无瘤生存率的影响.结果 经免疫组化染色,有9.07%(191/2 106)的淋巴结出现CK20阳性表达;有26.67%(32/120)患者的淋巴结中出现CK20阳性表达,其中11例(9.17%)为微转移,21例(17.50%)为孤立肿瘤细胞巢(ITC).术后随访24～121个月(平均66.35个月).淋巴结中CK20阴性表达、ITC和微转移的患者,5年无瘤生存率分别为87.4%、78.3%和40.9%.5年无瘤生存率在淋巴结CK20出现微转移者中明显低于CK20阴性表达者(P＝0.000)和以ITC为特征者(P＝0.046),而仅以ITC为特征者与CK20阴性表达者间比较,差异无统计学意义(P＝0.253).淋巴结中CK20阳性表达与胃癌患者的肿瘤直径(P＝0.011)、浸润胃壁深度(P＝0.043)和是否有淋巴管浸润(P＝0.002)有关.所有临床病理因素对5年无瘤生存率均无明显影响(P>0.05).11例胃癌患者被检测出微转移,应划分为pN1(Mi)期,本组重新分期率9.17%.而88例胃癌患者淋巴结CK20(-)和21例表达为ITC,分别被记为pN0(I-)和pN0(I+),不建议重新分期,仍为pN0期.结论 对于pT1～3N0期胃癌,若淋巴结中检测出微转移,其预后较差,术后5年无瘤生存率较低,建议术后应予以积极的辅助治疗.     

Early Versus Deferred Cystectomy for Initial High-Risk pT1G3 Urothelial Carcinoma of the Bladder: Do Risk Factors Define Feasibility of Bladder-Sparing Approach?

OBJECTIVES: We compared long-term outcome in patients with initial pT1G3 bladder cancer (BC) treated with early versus deferred cystectomy (CX) for recurrent pT1G3 or muscle-invasive BC after an initial bladder-sparing approach. The aim of this study was to compare survival rates and to analyse the influence of the recognised risk factors multifocality, tumour size, and carcinoma in situ (CIS) in initial transurethral resection of the bladder. METHODS: Between 1995 and 2005, a total of 105 patients were diagnosed with initial pT1G3 BC featuring>or=2 risk factors. Forty-five percent had multiple tumours, 73% tumours>3 cm in size, and 46% CIS. All patients were offered early CX. Fifty-one percent of patients opted for early and 49% underwent deferred CX for recurring BC. Risk factors were distributed evenly between the groups. RESULTS: Upstaging in the CX specimen was found in 30% of cases. No risk factor was related to upstaging. The 10-yr cancer-specific survival rate was 78% in early CX and 51% in deferred CX (p<0.01). No risk factor predicted cancer-related death in early CX. In survival analysis, CIS was related to a lower cancer-specific survival rate in deferred CX (p<0.001). CONCLUSIONS: Early as opposed to deferred CX seems to prolong the cancer-specific survival rate in high-risk pT1G3 BC. Patients with CIS should be considered for early CX owing to reduced cancer-specific survival in case of deferred CX.     

The role of adjuvant chemotherapy in patients with locally advanced (pT3, pT4a) and/or lymph node–positive bladder cancer

Objective  

To report the long-term follow up of patients with locally advanced bladder cancer treated with either adjuvant chemotherapy with gemcitabine/cisplatin (GC) or methotrexate, vinblastine, epirubicin, and cisplatin (MVEC) or no additional treatment after radical cystectomy, to examine various survival endpoints and factors associated with long-term survival.     

Is a second transurethral resection necessary for newly diagnosed pT1 bladder cancer?

PURPOSE: We evaluated the potential benefit of a second transurethral resection in patients with newly diagnosed pT1 transitional cell carcinoma of the bladder. MATERIALS AND METHODS: Between January 2001 and May 2003, 80 patients with stage T1 bladder cancer were included in this protocol in which all patients prospectively received second TUR within 2 to 6 weeks following the initial resection. Patients with incomplete resections were excluded from study. The pathological findings of the second TUR were reviewed. RESULTS: Of the 80 patients who underwent second resection, 18 (22.5%) had macroscopic tumors before resection. However, with the addition of microscopic tumors, overall residual disease was determined in 27 (33.8%) patients. Of the 27 patients 7 had pTa, 14 had pT1, 3 had pT1+pTis and 3 had pT2 disease. Residual cancers were detected in 5.8%, 38.2% and 62.5% in G1, G2 and G3 tumors, respectively. The risk of residual tumor directly correlated with the grade of the initial tumor (p = 0.009). CONCLUSIONS: Although second TUR dramatically changed the treatment strategy in a small percentage of cases, we strongly recommend performing second TUR in all cases of primary pT1 disease, especially in high grade cases.     

The significance of microscopic bladder neck invasion in radical prostatectomies: pT4 disease?

Introduction  It is controversial whether microscopic invasion of the bladder neck (BN) has a high risk for biochemical progression following radical prostatectomy (RP). The tumor, node, and metastasis (TNM) classification for prostate cancer considers BN involvement to be pT4 disease, equivalent to rectal or external sphincter invasion, however, it does not specify whether the invasion is macroscopic or microscopic. Materials and methods  Clinicopathological findings were studied from 290 patients submitted to RP. The time to biochemical (prostate-specific antigen, PSA) progression-free outcome for patients with BN invasion was compared to patients with extraprostatic extension (EPE) or seminal vesicle invasion (SVI). A univariate Cox proportional hazards model was created and a final multivariate Cox proportional hazards model was developed to assess the influence of several variables simultaneously. Results  BN invasion was present in 55/290 (18.96%) surgical specimens and 18/290 (6.2%) also showed positive surgical margins. Patients with microscopic BN invasion had significantly higher preoperative PSA, higher Gleason score, higher apical and circumferential positive surgical margins, more advanced pathological stage, and more extensive tumors. At 5 years 42%, 40%, and 27% of the patients with BN invasion, extraprostatic extension (EPE), and seminal vesicle invasion (SVI), respectively, were free of biochemical recurrence following RP. In multivariate analysis, BN invasion did not contribute for a higher relative hazard of PSA recurrence when added to EPE or SVI. Conclusion  BN invasion is associated with adverse clinicopathological findings. However, the biochemical-free outcome following RP is similar to patients with EPE but significantly better than patients with SVI. The findings of this study do not favor considering microscopic bladder neck invasion as stage pT4 but, probably, stage pT3a.