TY - JOUR
T1 - The World Health Organization 1973 classification system for grade is an important prognosticator in T1 non-muscle-invasive bladder cancer
AU - van de Putte, Elisabeth E. Fransen
AU - Bosschieter, Judith
AU - van der Kwast, Theo H.
AU - Bertz, Simone
AU - Denzinger, Stefan
AU - Manach, Quentin
AU - Compérat, Eva M.
AU - Boormans, Joost L.
AU - Jewett, Michael A. S.
AU - Stoehr, Robert
AU - van Leenders, Geert J. L. H.
AU - Nieuwenhuijzen, Jakko A.
AU - Zlotta, Alexandre R.
AU - Hendricksen, Kees
AU - Rouprêt, Morgan
AU - Otto, Wolfgang
AU - Burger, Maximilian
AU - Hartmann, Arndt
AU - van Rhijn, Bas W. G.
PY - 2018/12/1
Y1 - 2018/12/1
N2 - 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–Guérin) in four hospitals. Grade was defined according to WHO1973 (Grade 1–3) and WHO2004 (low-grade [LG] and high-grade [HG]). This resulted in a lack of Grade 1 tumours, 188 (31%) Grade 2, and 413 (69%) Grade 3 tumours. There were 47 LG (8%) vs 554 (92%) HG tumours. We determined the prognostic value for progression-free survival (PFS) and cancer-specific survival (CSS) in Cox-regression models and corrected for age, sex, multiplicity, size and concomitant carcinoma in situ. Results: At a median follow-up of 5.9 years, 148 patients showed progression and 94 died from BC. The WHO1973 Grade 3 was negatively associated with PFS (hazard ratio [HR] 2.1) and CSS (HR 3.4), whilst WHO2004 grade was not prognostic. On multivariable analysis, WHO1973 grade was the only prognostic factor for progression (HR 2.0). Grade 3 tumours (HR 3.0), older age (HR 1.03) and tumour size >3 cm (HR 1.8) were all independently associated with worse CSS. Conclusion: The WHO1973 classification system for grade has strong prognostic value in T1-BC, compared to the WHO2004 system. Our present results suggest that WHO1973 grade cannot be replaced by the WHO2004 classification in non-muscle-invasive BC guidelines.
AB - 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–Guérin) in four hospitals. Grade was defined according to WHO1973 (Grade 1–3) and WHO2004 (low-grade [LG] and high-grade [HG]). This resulted in a lack of Grade 1 tumours, 188 (31%) Grade 2, and 413 (69%) Grade 3 tumours. There were 47 LG (8%) vs 554 (92%) HG tumours. We determined the prognostic value for progression-free survival (PFS) and cancer-specific survival (CSS) in Cox-regression models and corrected for age, sex, multiplicity, size and concomitant carcinoma in situ. Results: At a median follow-up of 5.9 years, 148 patients showed progression and 94 died from BC. The WHO1973 Grade 3 was negatively associated with PFS (hazard ratio [HR] 2.1) and CSS (HR 3.4), whilst WHO2004 grade was not prognostic. On multivariable analysis, WHO1973 grade was the only prognostic factor for progression (HR 2.0). Grade 3 tumours (HR 3.0), older age (HR 1.03) and tumour size >3 cm (HR 1.8) were all independently associated with worse CSS. Conclusion: The WHO1973 classification system for grade has strong prognostic value in T1-BC, compared to the WHO2004 system. Our present results suggest that WHO1973 grade cannot be replaced by the WHO2004 classification in non-muscle-invasive BC guidelines.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85051720871&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29637669
U2 - https://doi.org/10.1111/bju.14238
DO - https://doi.org/10.1111/bju.14238
M3 - Article
C2 - 29637669
SN - 1464-4096
VL - 122
SP - 978
EP - 985
JO - BJU international
JF - BJU international
IS - 6
ER -