【摘要】 目的评估WHO2004分级法对随访5年以上膀胱非肌层浸润性尿路上皮癌的预测复发价值。方法TNM2002分期为Ta、T1膀胱原发性、非肌层浸润性尿路上皮癌94例,随访5年,分别进行WHO1973和WHO2004分级;采用免疫组化法测定Ki-67增殖指数(PI),PI<33%为低PI组,>66%为高PI组,33%～66%为中PI组;统计分析采用SPSS 13.0软件包。结果WHO1973分级法中,G1、G2和G3级分别有42、38和14例,Ki-67平均PI分别为(10.32±5.46)%、(22.52±7.42)%和(35.25±9.32)%。WHO2004分级法中,低度恶性倾向尿路上皮乳头状瘤(PUNLMP)、低分级尿路上皮癌(LGC)和高分级尿路上皮癌(HGC)分别有13、60和21例,Ki-67平均PI分别为(8.67±4.32)%、(21.23±6.24)%和(42.35±9.42)%。Ki-67平均PI在两种分级法间比较差异无统计学意义(P>0.05),但各分级法中两两比较差异有统计学意义(P<0.05),并随着癌分化程度的降低,Ki-67平均PI均逐渐增高。随访5年,有43例复发(45.7%)。单因素Kaplan-Meier生存分析显示,Ki-67平均PI、WHO1973和WHO2004病理分级均与膀胱癌无复发生存率密切相关(P<0.01),其中低、中、高PI各组间复发率不同(P<0.01);WHO1973分级法中各组均有复发,但G1与G2级间比较差异无统计学意义(P>0.05);WHO2004分级法中各组间两两比较差异均有统计学意义(P<0.01),其中PUNLMP组复发3例。结论WHO2004分级法更能准确反映膀胱肿瘤的复发倾向。更多还原

【Abstract】 Objective To evaluate the value of WHO 2004 histological classification in predicting recurrence of non-muscular invasive bladder urothelial cancer. Methods A total of 94 cases of patients with primary urinary bladder non-muscular invasive urothelial cancer with TNM 2002 stages Ta,T1 were followed-up 5 years after transurethral resection and intravesical chemotherapy,graded with WHO 1973 and WHO 2004 classification respectively.Ki-67 proliferation index(PI)was detected by SP immunohistochemistry.Ki-67 PI<33% for the low PI group,>66% for the high PI group,between them for the intermediate PI group. Results According to WHO 1973 classification,42 cases with G1,38 with G2,14 with G3,the Ki-67 average PI were(10.32±5.46)%,(22.52±7.42)% and(35.25±9.32)% respectively.Regarding by WHO 2004 classification showed that 13,60 and 21 cases were papillary urothelial neoplasm of low malignant potential(PUNLMP),non-invasive low grade papillary urothelial carcinoma(LGC) and non-invasive high grade papillary urothelial carcinoma(HGC).The Ki-67 average PI were(8.67±4.32)%,(21.23±6.24)% and(42.35±9.42)% respectively.Ki-67 PI showed no significant difference(P>0.05) between two groups while inside each groups the difference were significant(P<0.05).Ki-67 PI was gradually increased along with tumor differentiation reduced.During 5-year followed-up,43 cases recurred(45.7%).Ki-67 average PI,WHO 1973 classification and WHO 2004 classification were respectively related to recurrence-free survival rate(P<0.01) according to Kaplan-Meier survival analysis.The recurrence rate between three Ki-67 PI groups was different(P<0.01).Comparing G1 with G2 was not different(P>0.05) although each grade of WHO 1973 classification had relapsed.Nevertheless,each WHO 2004 classification group’s recurrence rate were significant difference(P<0.01),in which 3 PUNLMP were recurred. Conclusions WHO 2004 classification more accurately predicts the tendency of recurrence of non-muscular invasive bladder urothelial cancer.更多还原