Mixed low- and high-grade non-muscle-invasive bladder cancer: a histological subtype with favorable outcome

Abstract

Mixed low- and high-grade NMIBC exhibits a significantly better response profile to intravesical BCG therapy compared to PHG NMIBC. The implications of these results are that less aggressive treatment strategies for this unique cancer entity may be needed and that there is a benefit to the reporting of tumor heterogeneity in transurethral resection of bladder tumor specimens.

Analysis of papillary urothelial carcinomas of the bladder with grade heterogeneity: supportive evidence for an early role of CDKN2A deletions in the FGFR3 pathway

“…Three recent publications have suggested that urothelial carcinomas with grade heterogeneity have a prognosis more in keeping with low‐grade carcinomas based on time to recurrence and disease‐free survival. However, previous literature has suggested that molecular markers may predict tumour behaviour more accurately than conventional histology .…”

“…However, previous literature has suggested that molecular markers may predict tumour behaviour more accurately than conventional histology . In all papers, carcinomas were categorized based on morphology alone. A different cut‐off was utilized in determining grade heterogeneity in each paper (<50%, <10% and <5%).…”

“…In all papers, carcinomas were categorized based on morphology alone. A different cut‐off was utilized in determining grade heterogeneity in each paper (<50%, <10% and <5%). In the publication by Reis et al ., almost one‐fifth of the cohort had multifocal disease and all patients had pTa tumours.…”

“…While this did not reach statistical significance, the numbers assessed were small ( n = 31). In the work by Schubert et al . the cohort was larger ( n = 153), but only 17 cases were mixed (<50% high grade); the remainder were pure high‐grade carcinomas and all were treated with a 6‐week course of bacillus Calmette–Guérin (BCG).…”

Management of noninvasive bladder cancers

“…The authors recommend that patients with high-grade T1 disease and LVI consider early cystectomy to preserve their chance for cure [26]. On the other end of the risk continuum are patients with mixed high-grade and low-grade NMIBC, an entity which Schubert et al [27] report is less aggressive than high-grade NMIBC alone and is less likely to require advanced intervention with radical cystectomy or non-BCG intravesical agents.…”