The WHO classification of 1973 is more suitable than the WHO classification of 2004 for predicting survival in pT1 urothelial bladder cancer (original) (raw)
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Journal of Cancer Research and Clinical Oncology, 1993
A group of 343 patients with bladder carcinomas was uniformly staged, both clinico-radiologically and pathologically. In accordance with pathological staging, they were treated from 1983 to 1990 and follow-up was closed on January 1992. No systemic chemotherapy regime was used. The present study was designed to assess the value of classical morphological parameters (tumour extension, histological subtype, grade and growth pattern) in the prediction of prognosis, and also to evaluate the adequacy of the current TNM classification (4th edition, 1987) of bladder cancer. The initial tumour stage appears the most useful criterion in the prediction of prognosis. Nevertheless, survival analysis confirms the necessity to modify the present TNM classification for routine clinical practice. In fact, stage III proves to be heterogeneous, and the difference in survival between categories pT3a and pT3b is even more statistically significant (logrankP<0.01) than the difference between pT2 and pT3 as a whole (log-rankP<0.02). Consequently, invasion of the muscular layer should be reclassified into a common stage II, equivalent to the B category in the ABCD system. Moreover, stage IV is also heterogeneous in terms of survival. Despite the overall life-expectancy being rather poor for a patient with bladder carcinoma, three subsets with different prognosis (log-rankP<0.001) can be identified: pT4N0M0; pTxN1-3M0; pTxNyM1, wherex andy represent any number. Therefore, we believe that various subgroups should be distinguished in a future edition of the TNM classification. Current treatment modalities, involving the role of systemic chemotherapy and aimed at bladder preservation, make such innovations even more convenient for a new edition of the TNM classification of bladder cancer. Apart from tumour staging, several microscopic morphological parameters are valuable in distinguishing patients with different prognosis. Pure transitional-cell histology, papillar growth, and low grade, are favourable data. In fact, tumour grade, although somewhat subjective, is a factor of major prognostic importance. Pauwels' distinction of intermedium grade 2 into 2A and 2B is also helpful in the assessment of a population of “intermediate” prognosis. Similarly, with regard to superficial tumours, the division of infiltration levels of subepithelial connective tissue into “superficial” or “deep into the muscularis mucosae”, is also relevant, even after stratification by grade.
Japanese Journal of Clinical Oncology, 2013
The aim of this study was to clarify the prognostic value and clinical reliability of the 2004 World Health Organization classification system of non-muscle-invasive bladder cancer. Methods: Between January 1995 and November 2010, 153 patients were diagnosed with nonmuscle-invasive bladder cancer. We used a substage system that discerns T1-microinvasive (T1m, 42 patients) and T1-extensive-invasive (T1e, 37 patients) cancers. Results: There were 2 (1.3%), 89 (58.2%) and 62 (40.5%) cases of Grade 1-3 urothelial carcinoma, respectively, on the basis of the 1973 World Health Organization classification system. Of these, 37 (24.2%) and 116 (75.8%) were graded as low and high on the basis of the 2004 World Health Organization classification system. All of the cases with progression (15 patients) were diagnosed as high grade at the time of primary transurethral resection of the bladder tumor. Based on the Kaplan-Meier analysis, the 2004 World Health Organization classification system accurately predicted tumor recurrence (P ¼ 0.029) and progression (P ¼ 0.031). The 5-year recurrence-free survival rates in patients with low-grade and high-grade tumors were 68.7 and 47.1%, and the 5-year progression-free survival rates were 100 and 89.0%, respectively. In the high-grade T1 cases, the substage (T1m or T1e) was a significant predictor of tumor recurrence (P ¼ 0.001) and progression (P ¼ 0.020). Conclusions: The 2004 World Health Organization classification system accurately predicts the risk of recurrence in primary non-muscle-invasive bladder cancer cases and has the same accuracy when predicting the risk of progression as the 1973 World Health Organization classification. Furthermore, the substaging system for high-grade T1 tumors is useful in predicting both recurrence and progression.
Virchows Archiv, 2002
Recently, two new classification systems for grading of urothelial neoplasms have been published. The objective of both was to avoid the overdiagnosis of cancer and to create better criteria for the grades. The WHO/ISUP classification of 1998 distinguishes papilloma, papillary urothelial neoplasm of low malignant potential (PUNLMP), low and high grade carcinomas, whereas the WHO 1999 system subdivides the high grade into grades II and III, and is otherwise identical. This note summarizes studies supporting the rationale of the two new systems, describes pattern recognition criteria for the grades, and highlights the homology between them.
British Journal of Medical and Surgical Urology, 2011
Aim: We assess the impact of the histological sub-classification of newly diagnosed G2 pT1 TCC bladder into low-grade and high-grade groups on the pattern of disease recurrence and progression. Method: A retrospective case note analysis of all newly diagnosed G2 pT1 TCC bladder between January 2003 and December 2007 was performed. The pattern of disease recurrence and progression was recorded and correlated with the histological grade of the original tumour. In addition, the use of adjuvant intravesical chemotherapy or immunotherapy was recorded and the effect of these agents noted. Results: 101 patients were included in the study of which 75 had high-grade disease, 14 had focally high-grade disease and 11 had low-grade disease. The recurrence rate was 42% in the high-grade group and 25% in the low-grade group. The progression rate was 13% in the high-grade group and no progression was seen in the low-grade group. Those patients with high-grade disease receiving adjuvant intravesical BCG (Bacillus Calmette-Guerin) immunotherapy had a progression rate of 6%, whereas those not receiving BCG treatment had a 18% progression rate.
Comparison of 10-year overall survival between patients with G1 and G2 grade Ta bladder tumors
Medicine, 2018
To compare long-term overall survival (OS) in patients with G1 and G2 grade Ta bladder cancer after transurethral resection of bladder tumors (TURBTs). Secondary aim was to investigate clinical and pathologic prognostic factors for OS of Ta patients, except G3/high grade (HG).A total of 243 patients, retrospectively selected, with Ta nonmuscle invasive bladder cancer (NMIBC) underwent TURBT between January 2006 and December 2008 (median follow-up 109 months). Inclusion criteria were: Ta at first manifestation, G1 or G2 grade with no associated carcinoma in situ (CIS). Seventy-nine patients were excluded due to concomitant CIS (1), G3/HG tumors (47), and lost to follow-up (31). Ethical approval was obtained from the Ethical Committee of the Mures County Hospital. Statistical analysis was performed using STATA 11.0.Following inclusion criteria, 164 patients with primary G1 or G2 Ta tumors, were enrolled. Recurrence was observed in 26 (15.8%) and progression in 5 (3%) patients. Ten-yea...
American Journal of Clinical Pathology, 2010
To verify prognostic significance of the 2004 World Health Organization (WHO)/International Society of Urological Pathology (ISUP) grading systems, we retrospectively studied the tumors of 1,515 patients who underwent transurethral resection of primary non-muscle-invasive urothelial tumors (pTa, 1,006 patients; pT1, 509 patients) confined to the bladder. Cases were classified according to the 2004 WHO/ISUP systems as 212 cases of papillary urothelial neoplasm of low malignant potential (PUNLMP), 706 low-grade papillary urothelial carcinomas (LPUCs), and 597 high-grade papillary urothelial carcinomas (HPUCs). PUNLMP showed the statistically significantly lowest recurrence cumulative incidence compared with the other tumor types. There were significant differences and trends for higher progression and cancer-specific mortality cumulative incidence in the following order: PUNLMP, LPUC, pTa HPUC, and pT1 HPUC. No differences of progression and cancer-specific mortality cumulative incidence were found between pTa and pT1 LPUC. Our study validates the usefulness of the 2004 WHO/ISUP system to classify urothelial tumors into prognostically distinct categories that would contribute to the design of therapeutic and monitoring strategies for patients with non-muscle-invasive bladder urothelial tumors. The grading of papillary urothelial neoplasms has been a long-standing issue of debate. Among numerous grading systems, the 1973 World Health Organization (WHO) system is the most commonly used. 1 However, a major limitation is its arbitrary definitions. In 1998, the International Society of Urological Pathology (ISUP) proposed a new grading system, 2 which was adopted in large measure by the WHO in 2004. 3 The new 2004 WHO/ISUP scheme, with the strength of clear-cut criteria for each entity and the aim of eliminating subjective and arbitrary interpretation, greatly improves the ambiguous language that marked the 1973 WHO system. In this study, we evaluated the efficiency of the 2004 WHO/ISUP classification for prediction of recurrence, progression, and cancer-specific mortality. The usefulness of the 2004 WHO/ISUP system has been described in a few reports, with sample size varying from 49 to 504 cases. 4-12 We collected a large cohort of patients with primary bladder non-muscle-invasive (pTa and pT1) urothelial tumors treated by transurethral resection (TUR). The large sample permitted us to stratify cases to procure detailed information from different strata. Materials and Methods Study Subjects This study was approved by the institutional review board of Taipei Veterans General Hospital, Taipei, Taiwan Upon completion of this activity you will be able to: • define the significance of 2004 World Health Organization (WHO)/ International Society of Urological Pathology (ISUP) classification of papillary urothelial tumors. • correlate the 2004 WHO/ISUP grade with recurrence, progression, and cancer-specific mortality of urinary bladder non-muscle-invasive urothelial tumors. • analyze the significant prognostic factors of urinary bladder non-muscle-invasive urothelial tumors.