Comparison between 1973 and 2004/2016 WHO grading systems in patients with Ta urothelial carcinoma of urinary bladder.

Published on Feb 23, 2021in Journal of Clinical Pathology3.411
· DOI :10.1136/JCLINPATH-2021-207400
Claudia Collà Ruvolo8
Estimated H-index: 8
,
Christoph Würnschimmel6
Estimated H-index: 6
+ 11 AuthorsPierre I. Karakiewicz119
Estimated H-index: 119
(UdeM: Université de Montréal)
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Abstract
AIMS To compare the 1973 WHO and the 2004/2016 WHO grading systems in patients with urothelial carcinoma of urinary bladder (UCUB), since no consensus has been made which classification should supersede the other and since both are recommended in clinical practice. METHODS Newly diagnosed patients with Ta UCUB treated with transurethral resection of bladder tumour were abstracted from the Surveillance, Epidemiology and End Results database (2010-2016). Kaplan-Meier plots and multivariable Cox regression models (CRMs) tested cancer-specific mortality (CSM), according to 1973 WHO (G1 vs G2 vs G3) and to 2004/2016 WHO (low-grade vs high-grade) grading systems. RESULTS Of 35 986 patients, according to 1973 WHO grading system, 8165 (22.7%) were G1, 17 136 (47.6%) were G2 and 10 685 (29.7%) were G3. According to 2004/2016 WHO grading system, 24 961 (69.4%) were low-grade versus 11 025 (30.6%) high-grade. In multivariable CRMs, G3 (HR: 2.05, p<0.001), relative to G1, and high-grade(HR: 2.13, p<0.001), relative to low-grade, predicted higher CSM. Conversely, G2 (p=0.8) was not an independent predictor. The multivariable models without consideration of either grading system were 74% accurate in predicting 5-year CSM. After addition of 1973 WHO or 2004/2016 WHO grade, the accuracy increased to 76% and 77%, respectively. CONCLUSIONS From a statistical standpoint, it appears that the 2004/2016 WHO grading system holds a small, although measurable advantage over the 1973 WHO grading system. Other considerations, such as intraobserver and interobserver variability may represent an additional matric to consider in deciding which grading system is better.
References16
Newest
#1Paramananthan Mariappan (Western General Hospital)H-Index: 16
#2Paul Fineron (Western General Hospital)H-Index: 5
Last. Kenneth M. Grigor (Edin.: University of Edinburgh)H-Index: 18
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PURPOSE: Paucity of reliable long-term data on the prognostic implications of the 2004 WHO bladder cancer classification system necessitates utilisation of both this and the 1973 grading systems. This study evaluated, in noninvasive (pTa) bladder tumours, the prognostic value of the 2004 system independently and in combination with the 1973 system while establishing concordance between tertiary centre uropathologists. METHODS: We used a cohort of non-muscle invasive bladder cancer (NMIBC) patien...
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#1Gianluigi Califano (University of Naples Federico II)H-Index: 6
#2Idir Ouzaid (University of Paris)H-Index: 5
Last. Evanguelos Xylinas (University of Paris)H-Index: 57
view all 6 authors...
Non-muscle invasive bladder cancer (NMIBC) is a highly heterogeneous disease that hides classes of patients who behave significantly differently under a favorable overall prognosis facade. Individual risk stratification and good decision making improve the patient outcomes. To date, radical cystectomy remains the treatment of choice in particularly aggressive subsets of disease, also due to the lack of proven alternative bladder-sparing strategies.Cancer immunotherapy, by inhibiting the PD-1/PD-...
#1V. Kvikstad (University of Stavanger)H-Index: 4
Last. Emiel A. M. Janssen (University of Stavanger)H-Index: 30
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European treatment guidelines for pTa and pT1 urinary bladder urothelial carcinoma depend highly on stage and WHO-grade. Both the WHO73 and the WHO04 grading systems show some intra- and interobserver variability. The current pilot study investigates which histopathological features are especially sensitive for this undesired lack of reproducibility and the influence on prognostic value. Thirty-eight cases of primary non-muscle invasive urothelial carcinomas, including thirteen cases with stage ...
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#1Elisabeth E. Fransen van de Putte (NKI-AVL: Netherlands Cancer Institute)H-Index: 12
#2Judith Bosschieter (VU: VU University Amsterdam)H-Index: 10
Last. Bas W.G. van RhijnH-Index: 54
view all 19 authors...
Objectives: To compare the prognostic value of the World Health Organization (WHO) 1973 and 2004 classification systems for grade in T1 bladder cancer (T1-BC), as both are currently recommended in international guidelines. Patients and Methods: Three uro-pathologists re-revised slides of 601 primary (first diagnosis) T1-BCs, initially managed conservatively (bacille Calmette–Guerin) in four hospitals. Grade was defined according to WHO1973 (Grade 1–3) and WHO2004 (low-grade [LG] and high-grade [...
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#1Eva Compérat (University of Paris)H-Index: 25
#2Maximilian Burger (University of Regensburg)H-Index: 53
Last. Marko Babjuk (Charles University in Prague)H-Index: 31
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Abstract Context In the management of urothelial carcinoma, determination of the pathological grade aims at stratifying tumours into different prognostic groups to allow evaluation of treatment results, and optimise patient management. This article reviews the principles behind different grading systems for urothelial bladder carcinoma discussing their reproducibility and prognostic value. Objective This paper aims to show the evolution of the World Health Organisation (WHO) grading system, disc...
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Abstract Context Tumour grade is an important prognostic indicator in non–muscle-invasive bladder cancer (NMIBC). Histopathological classifications are limited by interobserver variability (reproducibility), which may have prognostic implications. European Association of Urology NMIBC guidelines suggest concurrent use of both 1973 and 2004/2016 World Health Organization (WHO) classifications. Objective To compare the prognostic performance and reproducibility of the 1973 and 2004/2016 WHO gradin...
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#1Peter A. Humphrey (Yale University)H-Index: 88
#2Holger Moch (UZH: University of Zurich)H-Index: 117
Last. Victor E. Reuter (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 146
view all 5 authors...
Abstract It has been 12 yr since the publication of the last World Health Organization (WHO) classification of tumours of the prostate and bladder. During this time, significant new knowledge has been generated about the pathology and genetics of these tumours. Intraductal carcinoma of the prostate is a newly recognized entity in the 2016 WHO classification. In most cases, it represents intraductal spread of aggressive prostatic carcinoma and should be separated from high-grade prostatic intraep...
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#1Ok Målfrid Mangrud (Stavanger University Hospital)H-Index: 3
#2Rune Waalen (Innlandet Hospital Trust)H-Index: 1
Last. Jan P. A. Baak (Stavanger University Hospital)H-Index: 25
view all 7 authors...
Background European treatment guidelines of TaT1 urinary bladder urothelial carcinomas depend highly on stage and WHO1973-grade but grading reproducibility is wanting. The newer WHO2004 grading system is still debated and both systems are currently used.
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#1Zhongqing Chen (Fudan University)H-Index: 5
Background Predicting the recurrence and progression of Non-muscle-invasive bladder cancer(NMIBC) is critical for urologist. Histological grade provides significant prognostic information, especially for prediction of progression. Currently, the 1973 and the 2004 WHO classification co-exist. Which system is better for predicting rumor recurrence and progression still a matter for debate. Methodology/Principal Findings 348 patients diagnosed with Non-muscle invasive bladder cancer were enrolled i...
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#1Federico Pellucchi (UniSR: Vita-Salute San Raffaele University)H-Index: 15
#2Massimo Freschi (UniSR: Vita-Salute San Raffaele University)H-Index: 50
Last. Renzo Colombo (UniSR: Vita-Salute San Raffaele University)H-Index: 57
view all 9 authors...
Purpose: Histopathological grade remains the most important predictive factor for the prognosis of nonmuscle invasive bladder cancer. We defined the clinical reliability of the 2004 WHO and International Society of Urological Pathology histological classification system compared with that of the 1973 WHO system for Ta primary bladder tumors.Materials and Methods: We evaluated 270 consecutive patients with a first episode of low grade pTa bladder cancer at transurethral resection of the bladder b...
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Cited By1
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#2Christoph Würnschimmel (UniSR: Vita-Salute San Raffaele University)H-Index: 6
AIMS The European Association of Urology guideline for upper tract urothelial carcinoma (UTUC) relies on two grading system: 1973 World Health Organization (WHO) and 2004/2016 WHO. No consensus has been made which classification should supersede the other and both are recommended in clinical practice. We hypothesized that one may be superior to the other. METHODS Newly diagnosed non-metastatic UTUC patients treated with radical nephroureterectomy were abstracted from the Surveillance, Epidemiolo...
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