Reproducibility and Prognostic Variability of Grade and Lamina Propria Invasion in Stages Ta, T1 Urothelial Carcinoma of the Bladder

Bol, M G W; Baak, J. P. A.; Buhr-Wildhagen, Susanne B.K; Kruse, Arnold‐Jan; Kjellevold, Kjell H.; Janssen, Emiel A. M.; Mestad, Oddvar; Ogreid, P

doi:10.1097/01.ju.0000055471.78783.ae

Cited by 132 publications

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“…22 Progression was more common in the 20 consensus confirmed stage pT1 cases (25%) than in the 55 pTa and pT1 cases (20%). 22 Tumors that were downstaged to pTa showed less frequent progression than stage pT1 tumors (17 versus 25%), confirmed by review. It was concluded that prognostic variation resulting from observer variability in staging and grading is considerable with significant implications for patient management.…”

Section: Stage Pt0 Carcinomamentioning

confidence: 93%

“…21 In another study, there was complete interobserver agreement on pT1 stage among reviewers in 80% of cases, which rose to 88% after a second review. 22 Of the 63 tumors originally diagnosed as stage pT1, the consensus diagnosis by experienced genitourinary pathologists resulted in downstaging of 35 (56%) to pTa and upstaging of 8 (13%) to pT2-pT3 tumors. 22 Progression was more common in the 20 consensus confirmed stage pT1 cases (25%) than in the 55 pTa and pT1 cases (20%).…”

Section: Stage Pt0 Carcinomamentioning

confidence: 99%

“…22 Of the 63 tumors originally diagnosed as stage pT1, the consensus diagnosis by experienced genitourinary pathologists resulted in downstaging of 35 (56%) to pTa and upstaging of 8 (13%) to pT2-pT3 tumors. 22 Progression was more common in the 20 consensus confirmed stage pT1 cases (25%) than in the 55 pTa and pT1 cases (20%). 22 Tumors that were downstaged to pTa showed less frequent progression than stage pT1 tumors (17 versus 25%), confirmed by review.…”

Section: Stage Pt0 Carcinomamentioning

confidence: 99%

“…It was concluded that prognostic variation resulting from observer variability in staging and grading is considerable with significant implications for patient management. 22 The high rate of congruence between trained observers also implies that interobserver variation can be reduced by agreement on criteria for invasion.…”

Section: Stage Pt0 Carcinomamentioning

confidence: 99%

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Staging and reporting of urothelial carcinoma of the urinary bladder

et al. 2009

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Section: Stage Pt0 Carcinomamentioning

confidence: 93%

Section: Stage Pt0 Carcinomamentioning

confidence: 99%

Section: Stage Pt0 Carcinomamentioning

confidence: 99%

Section: Stage Pt0 Carcinomamentioning

confidence: 99%

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Staging and reporting of urothelial carcinoma of the urinary bladder

et al. 2009

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“…Thus, to the best of our knowledge, there are only two systematic studies involving more than 100 invasive cancer cases including both univariate and multivariate statistical analyses with respect to recurrence-free and disease-specific survival. 12,24 Moreover, the assessment of tumor grade may show considerable observer variation, 26 and the new two-tiered WHO grading system 27,28 has only rarely been applied with respect to prognostic impact in upper urinary tract UC. 22,24 Thus, other factors accurately predicting the biological potential of this malignancy are required to select candidates for adjuvant therapy.…”

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confidence: 99%

pT classification, grade, and vascular invasion as prognostic indicators in urothelial carcinoma of the upper urinary tract

et al. 2006

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Clinicopathologic features predictive of patient outcome in upper urinary tract urothelial carcinoma are not well defined. The aim of this study was to assess the role of pT classification, tumor grade, and vascular invasion in predicting metastasis-free survival. A total of 190 consecutive invasive upper urinary tract urothelial cancers operated between 01/1984 and 12/2004 were re-evaluated with respect to pT classification, tumor grade (according to the three-tiered WHO 1973 and the recent two-tiered grading system following the WHO/ISUP consensus classification), as well as presence of lymph and/or blood vessel invasion. Prognostic impact was analyzed using the Kaplan-Meier method and the Log-Rank test. For multivariate testing, a Cox's proportional hazards regression model was used. pT1 was present in 81 (43%), pT2 in 29 (15%), pT3 in 73 (38%), and pT4 in seven (4%) cases. There were 12 (6%) G1, 96 (51%) G2, and 82 (43%) G3 tumors or 84 (44%) low-grade and 106 (56%) high-grade tumors according to the two-tiered system. The presence of vascular invasion in 72/190 (38%) tumors was associated with high pT classification (Po0.001) and high tumor grade (Po0.001). Disease progression occurred in 39% of patients, with 5-and 10-year metastasis-free survival rates of 56 and 45%, respectively. On univariate analysis, all investigated parameters showed prognostic significance. The negative influence of vascular invasion on patient outcome was strikingly strong in high pT classification and high-grade cancers. On multivariate analysis, pT classification (Po0.001) and vascular invasion (Po0.001) proved to be independent prognostic factors, whereas tumor grade according to the two-tiered system missed statistical significance (P ¼ 0.06). In conclusion, pT classification and vascular invasion are independent prognostic factors with respect to metastasis-free survival and should be used to guide adjuvant therapy strategies in affected patients. Presence (or absence) of vascular invasion should be commented upon separately in the pathology report. Modern Pathology (2006Pathology ( ) 19, 272-279. doi:10.1038 Keywords: urothelial carcinoma; upper urinary tract; tumor classification; tumor grade; vascular invasion; prognosis A significant proportion of patients with upper urinary tract urothelial carcinoma (UC) eventually die of the disease due to unrecognized and untreated nodal or distant metastasis present at the time of surgery, indicating the importance of adequate adjuvant therapy strategies for patients at high risk of failure. Initial tumor stage and tumor grade have been documented as major prognostic factors. 1-25 However, validity of most studies is limited due to inclusion of noninvasive (pTa) cancer cases and/or small sample size. Thus, to the best of our knowledge, there are only two systematic studies involving more than 100 invasive cancer cases including both univariate and multivariate statistical analyses with respect to recurrence-free and disease-specific survival. 12,24 Moreover, the assessment of tumor gr...

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