背景:肌肉浸润性(MIBC)和转移性(mBC)膀胱癌的不同组织学可以定义癌症治疗方式和肿瘤结局。
目的:确定尿路上皮和非尿路上皮组织学变异的治疗对MIBC和mBC肿瘤预后的影响和影响。
方法:Medline,Embase,Cochrane对照试验数据库,和ClinicalTrials.gov进行了系统搜索。纳入了2000年以后发表的前瞻性和回顾性比较研究以及单臂病例系列中具有MIBC或/和mBC组织学变异的患者。治疗结果(总体,无复发,和疾病特异性存活率)被提取并报告。使用预后研究质量工具进行偏倚风险(RoB)评估。
结果:搜索产生了2450篇独特的文章,其中41篇文章涉及27672例组织学变异患者。28项研究进行了比较研究设计。看到了两种不同的研究设置:没有集中病理审查的大型数据库研究和由泌尿病理学家重新审查的小型系列研究。尽管大多数组织学变异在根治性膀胱切除术(RC)后显示相似的肿瘤学结果,印戒细胞,梭形细胞,与纯尿路上皮膀胱癌(PUC)相比,神经内分泌肿瘤的生存率较低。由于潜在的误导性解释和报告以及研究之间的巨大异质性,使用叙述性综合方法代替亚组分析.大多数研究都有适度的RoB。
结论:关于变异型组织学的预后和治疗的数据仍然不成熟,主要在膀胱切除术患者中进行评估。在此系统回顾的基础上,所有MIBC患者均应接受RC治疗.新辅助化疗对微乳头状瘤患者可能有益,浆细胞样细胞,肉瘤样,和混合变体,尤其是神经内分泌肿瘤患者。转移性膀胱癌应作为PUC治疗。
■在本报告中,我们观察了不同膀胱癌组织学的预后和治疗。我们发现,结果随组织学差异而变化,适当的治疗应基于组织学发现。
BACKGROUND: Variant histology of muscle-invasive (MIBC) and metastatic (mBC) bladder cancer may define the cancer treatment modality and oncological outcomes.
OBJECTIVE: To determine the prognostic effect and impact of therapy of urothelial and nonurothelial histological variants on the oncological outcomes of MIBC and mBC.
METHODS: Medline, Embase, Cochrane controlled trial databases, and ClinicalTrials.gov were systematically searched. Patients with histological variants of MIBC or/and mBC from prospective and retrospective comparative studies and single-arm case series published after the year of 2000 were included. Treatment outcomes (overall, recurrence-free, and disease-specific survival) were extracted and reported. Risk of bias (RoB) assessment was performed using Quality in Prognosis Studies tool.
RESULTS: The search yielded 2450 unique articles, of which 41 articles involving a total of 27 672 patients with histological variants were included. Twenty-eight studies had a comparative study design. Two different study settings were seen: large database studies without centralised pathological
review and small series with re-
review by uropathologists. Although most of the histological variants show similar oncological outcomes after radical cystectomy (RC), signet ring cell, spindle cell, and neuroendocrine tumours showed inferior survival compared with pure urothelial bladder cancer (PUC). Owing to potential misleading interpretations and reporting as well as large heterogeneity between studies, a narrative synthesis approach instead of subgroup analyses was used. Most studies had a moderate RoB.
CONCLUSIONS: The data about prognosis and treatment of the variant histology are still immature and assessed mostly in cystectomy patients. Based on this systematic
review, all patients with MIBC should be treated with RC. Neoadjuvant chemotherapy may be beneficial for patients with micropapillary, plasmacytoid, sarcomatoid, and mixed variants, and especially for patients with neuroendocrine tumours. Metastatic bladder cancer should be treated as PUC.
UNASSIGNED: In this report, we looked at the prognosis and treatment of different bladder cancer histologies. We found that outcomes varied with divergent histologies and appropriate treatment should be based on the histological finding.