J Cancer 2017; 8(15):2885-2891. doi:10.7150/jca.20003

Research Paper

Papillary Urothelial Neoplasm of Low Malignant Potential (PUNLMP) After Initial TUR-BT: Comparative Analyses with Noninvasive Low-Grade Papillary Urothelial Carcinoma (LGPUC)

Jung Kwon Kim1, Kyung Chul Moon2, Chang Wook Jeong3, Cheol Kwak3, Hyun Hoe Kim3, Ja Hyeon Ku3✉

1. Department of Urology, Center for Prostate Cancer, Research Institute and Hospital of the National Cancer Center, Goyang, Korea;
2. Department of Pathology, Seoul National University Hospital, Seoul, Korea;
3. Department of Urology, Seoul National University Hospital, Seoul, Korea.

Abstract

Purpose: To verify if the distinction between papillary urothelial neoplasm of low malignant potential (PUNLMP) and noninvasive low-grade papillary urothelial carcinoma (LGPUC) reflects a different biologic activity.

Materials and Methods: We reviewed and analyzed the clinical data from 678 patients who had a diagnosis of PUNLMP (n=53) or noninvasive LGPUC (n=625) after initial TUR-BT for bladder neoplasm between 2000 and 2012.

Results: The noninvasive LGPUC group showed a higher frequency of recurrence in comparison with the PUNLMP group (46.7% vs. 30.2%, p=0.022). In contrast, there were no significant differences in progression (15.2% vs. 18.9%, p=0.295) between the two groups. Grade progression was reported in 10 patients (LG: n=5; high grade: n=2; carcinoma in situ: n=3) and stage progression was reported in 2 patients (all: T1) in PUNLMP group. The Kaplan-Meier survival analysis showed significantly decreased 5-year recurrence-free survival (RFS) (50.3% vs. 74.6%, log-rank test, p=0.014) in the noninvasive LGPUC group compared to the PUNLMP group. However, there were no significant differences in progression-free survival (PFS) between the two groups. Multivariate analysis revealed that tumor grades according to 2004 WHO/ISUP classification system (PUNLMP vs. LG) were identified as significant predictors of RFS. However, it was not a significant predictor of both PFS and overall survival.

Conclusions: PUNLMP had a substantial number of recurrences (30.2%), although RFS was better than noninvasive LGPUC. In addition, PUNLMP had a similar risk of progression compared with noninvasive LGPUC. Consequently, PUNLMP should be treated in a manner similar to noninvasive LGPUC, and long-term clinical follow-up should be recommended for patients with PUNLMP.

Keywords: noninvasive low-grade papillary urothelial carcinoma, progression, PUNLMP, recurrence, urothelial carcinoma.

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How to cite this article:
Kim JK, Moon KC, Jeong CW, Kwak C, Kim HH, Ku JH. Papillary Urothelial Neoplasm of Low Malignant Potential (PUNLMP) After Initial TUR-BT: Comparative Analyses with Noninvasive Low-Grade Papillary Urothelial Carcinoma (LGPUC). J Cancer 2017; 8(15):2885-2891. doi:10.7150/jca.20003. Available from http://www.jcancer.org/v08p2885.htm