Grading of Human Urothelial Carcinoma Based on Nuclear Atypia and Mitotic Frequency. II. Histological Description

Abstract

A grading system was applied in a retrospective study of 124 patients with transitional cell carcinoma of the bladder using a modified Bergkvist system. The intermediate World Health Organization (WHO) grade II tumors were divided into supposedly benign and malignant forms of grades IIa and IIb, respectively. The 5-year survival was 92% for patients with grade IIa urothelial carcinoma, compared to 43% for patients with grade IIb tumors. The corresponding figures for grades I and III tumors were 100 and 44%, respectively. When excluding carcinoma in situ (5-year survival 50%) no patient with a noninvasive tumor (stage Ta) died of bladder carcinoma within 5 years, compared to 50% of those with invasive cancers (stages T1 to T4). We propose a new grading system in which grades I and IIa are embraced as grade A, grades IIb and III as grade B, and grade IV as grade C. The 5-year survival rate in the 3 grades was 94, 44 and 27%, respectively. Grade A seems to represent a type of tumor with universally favorable prognosis, in contrast to grades B and C. This offers practical advantages, since the former can be treated conservatively, whereas the latter need more urgent radical intervention, especially in patients in whom invasive growth is recorded.

Cell proliferation of transitional cell bladder tumours determined by PCNA/cyclin immunostaining and its prognostic value

“…In univariate survival analysis the fraction of PCNA/cyclin positive nuclei predicted survival significantly like other histoquantitative methods (Blomjous et al, 1989;Lipponen et al, 1990a;1991a,b;Carbin et al, 1991). The results in papillary tumours were comparable to those from other quantitative methods (Lipponen et al, 1991a,b) whereas in superficial tumours PCNA/cyclin positivity was superior to morphometric methods in predicting survival.…”

“…In accor- Progression of TCC was related to fraction of nuclei positive for PCNA/cyclin. However, PCNA/cyclin positivity was inferior to mitotic frequency or flow cytometric variables (Lipponen et al, 1990b(Lipponen et al, , 1991cCarbin et al, 1991) in predicting progression since we could not establish independent predictive value for PCNA/cyclin in a multivariate analysis. Particularly in superficial tumours PCNA/cyclin was inferior to other proliferation indices in predicting progression (Lipponen et al, 1990b(Lipponen et al, , 1991c.…”

Prognostic Value of MIB-1 Score, p53, EGFr, Mitotic Index and Papillary Status in Primary Superficial (Stage pTa/T1) Bladder Cancer: A Prospective Comparative Study

“…Therefore, a number of two-grade systems have been presented for TCC that are based on flow cytometry [20, 21, 22]or morphometry [22]. Carbin et al [23]presented a modified Bergkvist grading system, including subjective and quantitative elements, which correlated well with the prognosis. Malmström et al [21]combined flow cytometric data and the results from blood group immunohistochemistry into a new grading system for TCC.…”

Comparative Analysis of MiB1 and p53 Expression in Human Bladder Tumors and Their Correlation with Cancer Progression

“…Bladder tumor proliferation has been extensively studied by assessment of the mitotic index [19], BrdUrd binding [20], flow cytometry [21], Ki67 labelling index on fresh nonfixed sections [20], and PCNA labelling index on fixed section [22]. Most of these studies have demonstrated a relationship between proliferation and tumor grade, stage and progression [19, 23].…”

“…Most of these studies have demonstrated a relationship between proliferation and tumor grade, stage and progression [19, 23]. However, tumor proliferation was still not taken into account in the classical management of bladder tumors.…”