背景:肉瘤样尿路上皮癌(SUC)是一种罕见且高度恶性的膀胱癌,预后不良。目前,关于膀胱SUC的影像学特征以及将其与常规尿路上皮癌(CUC)区分开的可靠指标的信息有限。我们研究的目的是确定膀胱SUC的独特影像学特征,并确定有助于其鉴别诊断的因素。
方法:这项回顾性研究纳入了22例膀胱SUC患者和61例CUC患者。临床,病理性,记录两组的CT/MRI数据,并使用单变量分析和多项逻辑回归进行比较,以区分SUC和CUC。
结果:大多数SUC位于膀胱三角区,并表现出较大的肿瘤大小,不规则形状,低ADC值,膀胱成像报告和数据系统(VI-RADS)评分≥4,存在坏死,和侵入性。单变量分析显示,在肿瘤位置方面存在显著差异,形状,最大长轴直径(LAD),短轴直径(SAD),ADC值,VI-RADS评分,坏死,奢侈的延伸(EVE),盆腔腹膜播散(PPS),SUC和CUC之间的肾积水/输尿管积液(p<.001〜p=.037)。多项逻辑回归发现,只有SAD(p=.014)和坏死(p=.003)成为区分SUC和CUC的独立预测因子。基于这两个因素的模型在ROC曲线分析中获得了0.849的曲线下面积(AUC)。
结论:膀胱SUC表现出几种不同的影像学特征,包括三角区的高发生率,大肿瘤大小,并伴有明显的侵袭性坏死。具有大SAD和坏死证据的膀胱肿瘤更可能是SUC而不是CUC。
BACKGROUND: Sarcomatoid urothelial carcinoma (SUC) is a rare and highly malignant form of bladder cancer with a poor prognosis. Currently, there is limited information on the imaging features of bladder SUC and reliable indicators for distinguishing it from conventional urothelial carcinoma (CUC). The objective of our study was to identify the unique imaging characteristics of bladder SUC and determine factors that aid in its differential diagnosis.
METHODS: This retrospective study enrolled 22 participants with bladder SUC and 61 participants with CUC. The clinical, pathologic, and CT/MRI data from both groups were recorded, and a comparison was conducted using univariate analysis and multinomial logistic regression for distinguishing SUC from CUC.
RESULTS: The majority of SUCs were located in the trigone of the bladder and exhibited large tumor size, irregular shape, low ADC values, Vesical Imaging-Reporting and Data System (VI-RADS) score ≥ 4, the presence of necrosis, and an invasive nature. Univariate analysis revealed significant differences in terms of tumor location, shape, the maximum long-axis diameter (LAD), the short-axis diameter (SAD), ADC-value, VI-RADS scores, necrosis, extravesical extension (EVE), pelvic peritoneal spread (PPS), and hydronephrosis/ureteral effusion (p < .001 ~ p = .037) between SUCs and CUCs. Multinomial logistic regression found that only SAD (p = .014) and necrosis (p = .003) emerged as independent predictors for differentiating between SUC and CUC. The model based on these two factors achieved an area under curve (AUC) of 0.849 in ROC curve analysis.
CONCLUSIONS: Bladder SUC demonstrates several distinct imaging features, including a high incidence of trigone involvement, large tumor size, and obvious invasiveness accompanied by necrosis. A bladder tumor with a large SAD and evidence of necrosis is more likely to be SUC rather than CUC.