In:
BJU International, Wiley, Vol. 122, No. 6 ( 2018-12), p. 978-985
Abstract:
To compare the prognostic value of the World Health Organization ( WHO ) 1973 and 2004 classification systems for grade in T1 bladder cancer (T1‐ BC ), as both are currently recommended in international guidelines. Patients and Methods Three uro‐pathologists re‐revised slides of 601 primary (first diagnosis) T1‐ BC s, initially managed conservatively (bacille Calmette–Guérin) in four hospitals. Grade was defined according to WHO 1973 (Grade 1–3) and WHO 2004 (low‐grade [ LG ] and high‐grade [ HG ]). This resulted in a lack of Grade 1 tumours, 188 (31%) Grade 2, and 413 (69%) Grade 3 tumours. There were 47 LG (8%) vs 554 (92%) HG tumours. We determined the prognostic value for progression‐free survival ( PFS ) and cancer‐specific survival ( CSS ) in Cox‐regression models and corrected for age, sex, multiplicity, size and concomitant carcinoma in situ . Results At a median follow‐up of 5.9 years, 148 patients showed progression and 94 died from BC . The WHO 1973 Grade 3 was negatively associated with PFS (hazard ratio [ HR ] 2.1) and CSS ( HR 3.4), whilst WHO 2004 grade was not prognostic. On multivariable analysis, WHO 1973 grade was the only prognostic factor for progression ( HR 2.0). Grade 3 tumours ( HR 3.0), older age ( HR 1.03) and tumour size 〉 3 cm ( HR 1.8) were all independently associated with worse CSS . Conclusion The WHO 1973 classification system for grade has strong prognostic value in T1‐ BC , compared to the WHO 2004 system. Our present results suggest that WHO 1973 grade cannot be replaced by the WHO 2004 classification in non‐muscle‐invasive BC guidelines.
Type of Medium:
Online Resource
ISSN:
1464-4096
,
1464-410X
DOI:
10.1111/bju.2018.122.issue-6
Language:
English
Publisher:
Wiley
Publication Date:
2018
detail.hit.zdb_id:
2019983-1
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