Prognostic Performance and Reproducibility of the 1973 and 2004/2016 World Health Organization Grading Classification Systems in Non–muscle-invasive Bladder Cancer: A European Association of Urology Non-muscle Invasive Bladder Cancer Guidelines Panel Systematic Review

Abstract

66Evidence acquisition: A systematic literature search was undertaken incorporating Medline, 67 Embase, and the Cochrane Library. Studies were critically appraised for risk of bias (QUIPS). 68For prognosis, the primary outcome was progression to muscle-invasive or metastatic 69 disease. Secondary outcomes were disease recurrence, overall and cancer-specific survival. 70For reproducibility, the primary outcome was inter-observer variability between 71 pathologists. Secondary outcome was intra-observer variability (repeatability) by the same 72 pathologist. Progression rates in G1 patients were similar to those in low grade patients; progression 77 rates in G3 patients were higher than in high grade patients. Survival data was limited.

Combined genetic and epigenetic alterations of the TERT promoter affect clinical and biological behavior of bladder cancer

“…14,29,30 A weakness of the WHO 2004/2016 pathological classification of NMIBC is that it gives almost no prognostic information in T1 patients as nearly all are classified as HG. 34 In our study, TERT promoter alterations add significant value as prognostic biomarkers. For example, T1 THOR low /TERTp Wt tumors, including HG lesions, carry a risk of progression of less than 10%, in sharp contrast with the 52% of progression for THOR high /TERTp Mut .…”

“…A weakness of the WHO 2004/2016 pathological classification of NMIBC is that it gives almost no prognostic information in T1 patients as nearly all are classified as HG . In our study, TERT promoter alterations add significant value as prognostic biomarkers.…”

“…Our study has limitations due to its retrospective nature, patient selection, absence of centralized pathology review (although we chose specifically the HG vs . LG 2004/16 WHO classification less prone to inter‐observer variability) . Importantly, one should interpret the univariate and multivariate analysis with caution as Ta ant T1 tumors are treated differently.…”

Staging of bladder cancer

“…Recurrence‐free and progression‐free survival were significantly worse in the grade 3 group compared to the grade 2 group. These data suggest that application of the 1973 grading system may be useful for substaging pT1 cancers …”

Comparison of perioperative outcomes in robot‐assisted radical cystectomy and laparoscopic radical cystectomy

“…Bladder cancer is one of the most common tumors of the urinary system, approximately 75% present as nonmuscle‐invasive bladder cancer (NMIBC) and 25% present as muscle‐invasive bladder cancer (MIBC) . Radical cystectomy (RC) with regional lymph node dissection is regarded as the standard treatment for MIBC and high‐risk NMIBC . Open RC (ORC) with regional lymph node dissection is considered to be the standard of care .…”