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Collà Ruvolo C, Würnschimmel C, Wenzel M, Nocera L, Celentano G, Mangiapia F, Tian Z, Shariat SF, Saad F, Chun FHC, Briganti A, Longo N, Mirone V, Karakiewicz PI. Comparison between 1973 and 2004/2016 World Health Organization grading in upper tract urothelial carcinoma treated with radical nephroureterectomy. Int J Clin Oncol 2021; 26:1707-1713. [PMID: 34091795 PMCID: PMC8364897 DOI: 10.1007/s10147-021-01941-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 05/21/2021] [Indexed: 12/29/2022]
Abstract
Aims The European Association of Urology guideline for upper tract urothelial carcinoma (UTUC) relies on two grading system: 1973 World Health Organization (WHO) and 2004/2016 WHO. No consensus has been made which classification should supersede the other and both are recommended in clinical practice. We hypothesized that one may be superior to the other. Methods Newly diagnosed non-metastatic UTUC patients treated with radical nephroureterectomy were abstracted from the Surveillance, Epidemiology, and End Results database (2010–2016). Kaplan–Meier plots and multivariable Cox regression models (CRMs) tested cancer-specific mortality (CSM), according to 1973 WHO (G1 vs. G2 vs. G3) or to 2004/2016 WHO (low-grade vs. high-grade) grading systems. Haegerty’s C-index quantified accuracy. Results Of 4271 patients, according to 1973 WHO grading system, 134 (3.1%) were G1, 436 (10.2%) were G2 and 3701 (86.7%) were G3; while according to 2004/2016 WHO grading system, 508 (11.9%) were low grade vs 3763 (88.1%) high grade. In multivariable CRMs, high grade predicted higher CSM (Hazard ratio: 1.70, p < 0.001). Conversely, neither G2 (p = 0.8) nor G3 (p = 0.1) were independent predictors of worse survival. The multivariable models without consideration of either grading system were 74% accurate in predicting 5-year CSM. Accuracy increased to 76% after either addition of the 1973 WHO or 2004/2016 WHO grade. Conclusions From a statistical standpoint, either 1973 WHO or 2004/2016 WHO grading system improves the accuracy of CSM prediction to the same extent. In consequence, other considerations such as intra- and interobserver variability may represent additional metrics to consider in deciding which grading system is better. Supplementary Information The online version contains supplementary material available at 10.1007/s10147-021-01941-9.
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Affiliation(s)
- Claudia Collà Ruvolo
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montreal, QC, Canada. .,Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy.
| | - Christoph Würnschimmel
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montreal, QC, Canada.,Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IBCAS San Raffaele Scientific Institute, Milan, Italy.,Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Mike Wenzel
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montreal, QC, Canada.,Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Luigi Nocera
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montreal, QC, Canada.,Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IBCAS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Celentano
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Francesco Mangiapia
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montreal, QC, Canada
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Departments of Urology, Weill Cornell Medical College, New York, NY, USA.,Department of Urology, University of Texas Southwestern, Dallas, TX, USA.,Department of Urology, Second Faculty of Medicine, Charles University, Prag, Czech Republic.,Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.,Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montreal, QC, Canada
| | - Felix H C Chun
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IBCAS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Longo
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Vincenzo Mirone
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montreal, QC, Canada
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Veccia A, Antonelli A, Martini A, Falagario U, Carrieri G, Grob MB, Guruli G, Simeone C, Wiklund P, Porpiglia F, Autorino R. Ureteral location is associated with survival outcomes in upper tract urothelial carcinoma: A population‐based analysis. Int J Urol 2020; 27:966-972. [DOI: 10.1111/iju.14336] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 06/30/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Alessandro Veccia
- Division of Urology Department of Surgery VCU Health System Richmond Virginia USA
- Urology Unit ASST Spedali Civili Hospital, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia Brescia Italy
| | - Alessandro Antonelli
- Urology Unit AUOI Verona Department of Surgery, Dentistry, Pediatrics and Gynecology University of Verona Verona Italy
| | - Alberto Martini
- Department of Urology Vita Salute San Raffaele University Milan Italy
- Department of Urology Icahn School of Medicine at Mount Sinai New York City New York USA
| | - Ugo Falagario
- Division of Urology Department of Surgery VCU Health System Richmond Virginia USA
- Department of Urology Icahn School of Medicine at Mount Sinai New York City New York USA
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences University of Foggia Foggia Italy
| | - Giuseppe Carrieri
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences University of Foggia Foggia Italy
| | - Mayer B Grob
- Division of Urology Department of Surgery VCU Health System Richmond Virginia USA
| | - Georgi Guruli
- Division of Urology Department of Surgery VCU Health System Richmond Virginia USA
| | - Claudio Simeone
- Urology Unit ASST Spedali Civili Hospital, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia Brescia Italy
| | - Peter Wiklund
- Department of Urology Icahn School of Medicine at Mount Sinai New York City New York USA
| | - Francesco Porpiglia
- Department of Urology “San Luigi Gonzaga” Hospital University of Turin Turin Italy
| | - Riccardo Autorino
- Division of Urology Department of Surgery VCU Health System Richmond Virginia USA
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