Prognostic Accuracy of Individual Uropathologists in Noninvasive Urinary Bladder Carcinoma: A Multicentre Study Comparing the 1973 and 2004 World Health Organisation Classifications

May, Matthias; Brookman-Amissah, S.; Roigas, Jan; Hartmann, Arndt; Störkel, Stephan; Kristiansen, Glen; Gilfrich, Christian; Borchardt, Roman; Hoschke, B.; Kaufmann, O.; Gunia, Sven

doi:10.1016/j.eururo.2009.03.052

Cited by 145 publications

(102 citation statements)

References 19 publications

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“…Furthermore, as the tumour grade of all patients with NMIBC was always assigned to a single expert uro-pathologist, the interobserver discrepancy for grading attribution could not be addressed. It should be recognised that, although a single-pathologist report can be seen as an advantage with respect to the continuity of the process over the years and reflecting many clinical routine contexts, it may also be considered the major criticism of the present results [21][22][23][24]. The absence in the multivariable analysis of histological microstaging and lymphovascular invasion (available for ∼50 and 30% of cases, respectively) might be considered as an additional limiting factor for results interpretation [25][26][27].…”

Section: Discussionmentioning

confidence: 80%

“…According to the EORTC risk tables, all pT1 G3 tumours should be considered at high risk for recurrence and progression and treated accordingly; however, it is not certain that we can translate this statement directly to the overall population with pT1 high grade tumours. Preliminary studies [14,15], including the study recently published by our group [16], have reported that the 2004 WHO grading system is a suitable and reliable prognostic factor with regard to papillary urothelial neoplasm of low malignant potential and pTa low grade urothelial carcinomas, but very few clinical studies specifically designed to investigate the prognostic reliability of the novel grading classification for pT1 high grade tumours have been completed. In addition, most of the published studies have included many limiting factors and many incorporated a heterogeneous patient population for both disease stage and tumour characteristics (recurrence, size, number, concomitant CIS).…”

Section: Discussionmentioning

confidence: 99%

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Oncological predictive value of the 2004 World Health Organisation grading classification in primary T1 non‐muscle‐invasive bladder cancer. A step forward or back?

et al. 2014

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ObjectiveTo compare the clinical reliability of the 1973 and 2004 World Health Organisation (WHO) classification systems in pT1 bladder cancer. Patients and MethodsWe retrospectively evaluated 291 consecutive patients who had pT1 high grade bladder cancer between 2004 and 2011. All tumours were simultaneously evaluated by a single uro-pathologist as high grade and G2 or G3. All patients underwent a second transurethral resection (TUR) and those confirmed with non-muscle-invasive bladder cancer at second TUR received bacille Calmette-Guérin. Follow-up included urine cytology and cystoscopy 3 months after second TUR and then every 6 months for 5 years. Univariate and multivariate analysis to determine recurrence-free survival (RFS) and progression-free survival (PFS) rates were performed using the Kaplan-Meier method with the log-rank test. ResultsG2 tumours were found in 124 (46.6%) and G3 in 142 (53.4%) patients. The mean (median; range) follow-up period was 31.1 (19; 1-93) months. The 5-year RFS rate was 39.1% for the overall high grade population, and 49.1 and 31.8% for G2 and G3 subgroups, respectively. The 5-year PFS was 82% for the overall high grade population and 89 and 73% for G2 and G3 subgroups, respectively. RFS (P < 0.002) and PFS (P < 0.001) rates were significantly different between the G2 and G3 subgroups. In multivariate analysis, only the grade assessed according to the 1973 WHO significantly correlated with both RFS (P = 0.003) and PFS (P < 0.001). ConclusionThe results suggest that the 1973 WHO classification system has higher prognostic reliability for patients with T1 disease. If confirmed, these findings should be carefully taken into account when making treatment decisions for patients with T1 bladder cancer.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Oncological predictive value of the 2004 World Health Organisation grading classification in primary T1 non‐muscle‐invasive bladder cancer. A step forward or back?

et al. 2014

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“…However, this pathological assessment highly depends on the experience of the pathologist and suffers from high-interobserver and -intraobserver variation. 8,25 Upgrading and upstaging could increase the 5-year progression risk up to 45%-according to the European Organisation of Research and Treatment of Cancer risk calculator. This emphasizes the importance of accurate pathological assessment.…”

Section: Discussionmentioning

confidence: 99%

Stratification based on methylation of TBX2 and TBX3 into three molecular grades predicts progression in patients with pTa-bladder cancer

et al. 2015

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The potential risk of recurrence and progression in patients with non-muscle-invasive bladder cancer necessitates followup by cystoscopy. The risk of progression to muscle-invasive bladder cancer is estimated based on the European Organisation of Research and Treatment of Cancer score, a combination of several clinicopathological variables. However, pathological assessment is not objective and reproducibility is insufficient. The use of molecular markers could contribute to the estimation of tumor aggressiveness. We recently demonstrated that methylation of GATA2, TBX2, TBX3, and ZIC4 genes could predict progression in Ta tumors. In this study, we aimed to validate the markers in a large patient set using DNA from formalin-fixed and paraffin-embedded tissue. PALGA: the Dutch Pathology Registry was used for patient selection. We included 192 patients with pTaG1/2 bladder cancer of whom 77 experienced progression. Methylation analysis was performed and log-rank analysis was used to calculate the predictive value of each methylation marker for developing progression over time. This analysis showed better progression-free survival in patients with low methylation rates compared with the patients with high methylation rates for all markers (Po0.001) during a followup of ten-years. The combined predictive effect of the methylation markers was analyzed with the Coxregression method. In this analysis, TBX2, TBX3, and ZIC4 were independent predictors of progression. On the basis of methylation status of TBX2 and TBX3, patients were divided into three new molecular grade groups. Survival analysis showed that only 8% of patients in the low molecular grade group progressed within 5 years. This was 29 and 63% for the intermediate-and high-molecular grade groups. In conclusion, this new moleculargrade based on the combination of TBX2 and TBX3 methylation is an excellent marker for predicting progression to muscle-invasive bladder cancer in patients with primary pTaG1/2 bladder cancer.

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“…Lokal patologların yüksek dereceli Ta olarak değerlendirdi-ği preparatların sadece %23 'ünün nihai sonucu yüksek dereceli Ta olarak kabul edilmiştir [7]. 2004 WHO sınıflamasında diğer sınıflamalara özellikle de 1973 sınıflandırmasına göre bu farklı-lıklar daha aza indirgenmiştir [11]. Sonuç olarak T evresi, CIS ve yüksek dereceli lezyonların ayrıntılı bir şekilde gözden geçirme-sini şiddetle önerilmektedir.…”

Section: Introductionunclassified

Recurrence and Progression Rate of High Grade Ta Bladder Cancer: 5-Year Follow up Results

Kılınç¹,

Sönmez²,

Ipek³

et al. 2015

Ann Clin Anal Med

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ÖzetAmaç: Sunulan bu çalışmanın amacı yüksek dereceli Ta mesane kanseri olan hasta grubunda rekürrens, progresyon oranları ve BCG tedavisinin başarısını incelemek. Gereç ve Yöntem: 1997-2005 yılları arasında kliniğimizde histopatolojik tanısı yüksek dereceli Ta mesane kanseri saptanan 6 hafta BCG terapisi ile tedavi edilen primer mesane kanseri olan 48 hasta incelendi. Ortalama 55,6 aylık takip süresince, hastalar sistoskopi ve gerektiğinde TUR ile takip edildi. Bu hastaların rekürrens, derece ve evre progresyonu analiz edildi. Bulgular: 48 hastanın 8'inde (%16.6) rekürrens izlenmedi. 14 (% 29.1) hastada Ta hastada rekürrens gözlenirken 11 (%22.9) hastada T1 evresine progresyon izlendi. 5 (%31.25) hastada kasa invazyon gözlenerek progresyon saptandı. Üç hasta (%6) mesane kanserinden öldü. Tümör sayısı, cinsiyet, yaş ve tümör boyutu kas invazyonunu öngören faktörler olarak görülmedi. CIS birlikteliği progresyon ile büyük oranda bağlantılı saptandı (p<0.001). Tartışma: Bizim çalışmamız; neredeyse %50 rekürrens ve %30 progresyon oranları gözlenen yüksek dereceli Ta mesane kanserinin progresyon açısından yüksek potansiyele sahip olduğunu göstermiştir. Bu sonuçlarda yüksek dereceli T1 mesane kanseri çalışmalarının daha önceki sonuçları ile karşılaştırıldığında benzerlik saptanabilir. Biz en az 5 yıllık dönemde takip protokollerine titizlikle uyularak rekürrensin erken bir aşamada tespit edilmesi gerektiğini düşünüyoruz. Anahtar KelimelerKas İnvaziv Olmayan Mesane Kanseri; Progresyon; Rekürrens; Yüksek Dereceli Ta Abstract Aim: The aim of the present study to evaluate recurrence and progression rates and success of BCG therapy, in a population with high grade Ta bladder cancer. Material and Method: Of the 45 patients treated and follow up at our institution from 1997 to 2005 for the histopathological diagnosis of primary bladder cancer with high grade Ta bladder cancer were treated with BCG weekly for 6 weeks. At a follow up of mean 55,6 months patients were evaluated with urinary cytology, cystoscopy, transurethral resection and random mucosal biopsies. Recurrence, grade and stage progression were analyzed. Results: Of the 48 patients 8 (16,6%) responded positively to BCG without recurrence, while disease recurred as stage Ta in 14 (29,1%) and progressed as stage T1 in 11 (22,9% ) at a five-year follow up, and progressed to muscle layer infiltration in 15 (31,25%). Three (6%) patients died of bladder cancer. The number of tumors, gender, age and size of tumors did not appear to be predictive factors of progression to muscle invasion but an association with carcinoma in situ appeared to correlate highly with progression (p <0.001). Discussion: Our study demonstrates the high progression potential of high grade Ta bladder cancer, since nearly 50% recurred and 30 % progressed to invasive disease. These results may be closely compared with the results of previous trials of high grade T1 bladder cancer. We suggest that recurrence should be detected at an early stage using long-term follow up with strict observance of the ...

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Prognostic Accuracy of Individual Uropathologists in Noninvasive Urinary Bladder Carcinoma: A Multicentre Study Comparing the 1973 and 2004 World Health Organisation Classifications

Cited by 145 publications

References 19 publications

Oncological predictive value of the 2004 World Health Organisation grading classification in primary T1 non‐muscle‐invasive bladder cancer. A step forward or back?

Oncological predictive value of the 2004 World Health Organisation grading classification in primary T1 non‐muscle‐invasive bladder cancer. A step forward or back?

Stratification based on methylation of TBX2 and TBX3 into three molecular grades predicts progression in patients with pTa-bladder cancer

Recurrence and Progression Rate of High Grade Ta Bladder Cancer: 5-Year Follow up Results

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