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Miyake M, Kitamura H, Nishimura N, Miyamoto T, Nakahama T, Fujii T, Matsumoto H, Matsuyama H, Yonemori M, Enokida H, Taoka R, Kobayashi T, Kojima T, Matsui Y, Nishiyama N, Nishiyama H, Fujimoto K. Validation of non-muscle-invasive bladder cancer risk stratification updated in the 2021 European Association of Urology guidelines. BJUI COMPASS 2024; 5:269-280. [PMID: 38371197 PMCID: PMC10869660 DOI: 10.1002/bco2.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 09/23/2023] [Accepted: 09/26/2023] [Indexed: 02/20/2024] Open
Abstract
Objective The objective of this study is to validate the predictive ability of the 2021 European Association of Urology (EAU) risk model compared to that of existing risk models, including the 2019 EAU model and risk scoring tables of the European Organization for Research and Treatment of Cancer, Club Urologico Espanol de Tratamiento Oncologico, and Japanese Nishinihon Uro-oncology Extensive Collaboration Group. Patients and methods This retrospective multi-institutional database study included two cohorts-3024 patients receiving intravesical bacillus Calmette-Guerin (BCG) treatment (BCG cohort) and 789 patients not receiving BCG treatment (non-BCG cohort). The Kaplan-Meier estimate and log-rank test were used to visualize and compare oncological survival outcomes after transurethral surgery among the risk groups. Harrell's concordance index (C-index) was used to evaluate the predictive ability of the models. Results We observed a risk shift from the 2019 EAU risk grouping to the 2021 EAU risk grouping in a substantial number of patients. For progression, the C-index of the 2021 EAU model was significantly higher than that of the 2019 EAU model in both the BCG (0.617 vs. 0.572; P = 0.011) and non-BCG (0.718 vs. 0.560; P < 0.001) cohorts. According to the 2021 EAU model, 731 (24%) and 130 (16%) patients in the BCG and non-BCG cohorts, respectively, were considered to have a very high risk. Survival analysis showed no significant differences among the five very high-risk subgroups in both cohorts. A major limitation was potential selection bias owing to the retrospective nature of this study. Conclusions The updated 2021 EAU model showed better stratification than the three existing risk models, especially for progression, in both cohorts, determining the most appropriate postoperative treatment and identifying patients requiring intensified surveillance or early cystectomy.
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Affiliation(s)
- Makito Miyake
- Department of UrologyNara Medical UniversityKashiharaNaraJapan
| | - Hiroshi Kitamura
- Department of Urology, Faculty of MedicineUniversity of ToyamaToyamaJapan
| | | | | | | | - Tomomi Fujii
- Department of Diagnostic PathologyNara Medical UniversityKashiharaNaraJapan
| | - Hiroaki Matsumoto
- Department of Urology, Graduate School of MedicineYamaguchi UniversityUbeYamaguchiJapan
| | - Hideyasu Matsuyama
- Department of Urology, Graduate School of MedicineYamaguchi UniversityUbeYamaguchiJapan
- Department of UrologyJA Yamaguchi Kouseiren Nagato General HospitalNagatoJapan
| | - Masaya Yonemori
- Department of Urology, Graduate School of Medical and Dental SciencesKagoshima UniversityKagoshimaJapan
| | - Hideki Enokida
- Department of Urology, Graduate School of Medical and Dental SciencesKagoshima UniversityKagoshimaJapan
| | - Rikiya Taoka
- Department of Urology, Faculty of MedicineKagawa UniversityTakamatsuKagawaJapan
| | - Takashi Kobayashi
- Department of UrologyKyoto University Graduate School of MedicineKyotoJapan
| | | | | | - Naotaka Nishiyama
- Department of Urology, Faculty of MedicineUniversity of ToyamaToyamaJapan
| | - Hiroyuki Nishiyama
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
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Paner GP, Kamat A, Netto GJ, Samaratunga H, Varma M, Bubendorf L, van der Kwast TH, Cheng L. International Society of Urological Pathology (ISUP) Consensus Conference on Current Issues in Bladder Cancer. Working Group 2: Grading of Mixed Grade, Invasive Urothelial Carcinoma Including Histologic Subtypes and Divergent Differentiations, and Non-Urothelial Carcinomas. Am J Surg Pathol 2024; 48:e11-e23. [PMID: 37382156 DOI: 10.1097/pas.0000000000002077] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
The 2022 International Society of Urological Pathology (ISUP) Consensus Conference on Urinary Bladder Cancer Working Group 2 was tasked to provide evidence-based proposals on the applications of grading in noninvasive urothelial carcinoma with mixed grades, invasive urothelial carcinoma including subtypes (variants) and divergent differentiations, and in pure non-urothelial carcinomas. Studies suggested that predominantly low-grade noninvasive papillary urothelial carcinoma with focal high-grade component has intermediate outcome between low- and high-grade tumors. However, no consensus was reached on how to define a focal high-grade component. By 2004 WHO grading, the vast majority of lamina propria-invasive (T1) urothelial carcinomas are high-grade, and the rare invasive low-grade tumors show only limited superficial invasion. While by 1973 WHO grading, the vast majority of T1 urothelial carcinomas are G2 and G3 and show significant differences in outcome based on tumor grade. No consensus was reached if T1 tumors should be graded either by the 2004 WHO system or by the 1973 WHO system. Because of the concern for underdiagnosis and underreporting with potential undertreatment, participants unanimously recommended that the presence of urothelial carcinoma subtypes and divergent differentiations should be reported. There was consensus that the extent of these subtypes and divergent differentiations should also be documented in biopsy, transurethral resection, and cystectomy specimens. Any distinct subtype and divergent differentiation should be diagnosed without a threshold cutoff, and each type should be enumerated in tumors with combined morphologies. The participants agreed that all subtypes and divergent differentiations should be considered high-grade according to the 2004 WHO grading system. However, participants strongly acknowledged that subtypes and divergent differentiations should not be considered as a homogenous group in terms of behavior. Thus, future studies should focus on individual subtypes and divergent differentiations rather than lumping these different entities into a single clinicopathological group. Likewise, clinical recommendations should pay attention to the potential heterogeneity of subtypes and divergent differentiations in terms of behavior and response to therapy. There was consensus that invasive pure squamous cell carcinoma and pure adenocarcinoma of the bladder should be graded according to the degree of differentiation. In conclusion, this summary of the International Society of Urological Pathology Working Group 2 proceedings addresses some of the issues on grading beyond its traditional application, including for papillary urothelial carcinomas with mixed grades and with invasive components. Reporting of subtypes and divergent differentiation is also addressed in detail, acknowledging their role in risk stratification. This report could serve as a guide for best practices and may advise future research and proposals on the prognostication of these tumors.
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Affiliation(s)
- Gladell P Paner
- Departments of Pathology and Surgery (Urology), University of Chicago, Chicago, IL
| | - Ashish Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - George J Netto
- Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL
| | - Hemamali Samaratunga
- Aquesta Uropathology, Brisbane, Queensland, Australia; University of Queensland, Brisbane, Queensland, Australia
| | - Murali Varma
- Department of Cellular Pathology, University Hospital of Wales, Cardiff, Wales, UK
| | - Lukas Bubendorf
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Theodorus H van der Kwast
- Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Brown University Warren Alpert Medical School; Lifespan Academic Medical Center, and the Legorreta Cancer Center at Brown University, Providence, RI
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Prospective Validation of the ROL System in Substaging pT1 High-Grade Urothelial Carcinoma: Results from a Mono-Institutional Confirmatory Analysis in BCG Treated Patients. Cancers (Basel) 2023; 15:cancers15030934. [PMID: 36765894 PMCID: PMC9913603 DOI: 10.3390/cancers15030934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Patients with pT1 high-grade (HG) urothelial carcinoma (UC) and a very high risk of progression might benefit from immediate radical cystectomy (RC), but this option remains controversial. Validation of a standardized method to evaluate the extent of lamina propria (LP) invasion (with recognized prognostic value) in transurethral resection (TURBT) specimens is still needed. The Rete Oncologica Lombarda (ROL) system showed a high predictive value for progression after TURBT in recent retrospective studies. The ROL system was supposed to be validated on a large prospective series of primary urothelial carcinomas from a single institution. From 2016 to 2020, we adopted ROL for all patients with pT1 HG UC on TURBT. We employed a 1.0-mm threshold to stratify tumors in ROL1 and ROL2. A total of 222 pT1 HG UC were analyzed. The median age was 74 years, with a predominance of men (73.8%). ROL was feasible in all cases: 91 cases were ROL1 (41%), and 131 were ROL2 (59%). At a median follow-up of 26.9 months (IQR 13.8-40.6), we registered 81 recurrences and 40 progressions. ROL was a significant predictor of tumor progression in both univariable (HR 3.53; CI 95% 1.56-7.99; p < 0.01) and multivariable (HR 2.88; CI 95% 1.24-6.66; p = 0.01) Cox regression analyses. At Kaplan-Meier estimates, ROL showed a correlation with both PFS (p = 0.0012) and RFS (p = 0.0167). Our results confirmed the strong predictive value of ROL for progression in a large prospective series. We encourage the application of ROL for reporting the extent of LP invasion, substaging T1 HG UC, and improving risk tables for urological decision-making.
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Lin L, Guo X, Ma Y, Zhu J, Li X. Does repeat transurethral resection of bladder tumor influence the diagnosis and prognosis of T1 bladder cancer? A systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:29-38. [PMID: 35752497 DOI: 10.1016/j.ejso.2022.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/26/2022] [Accepted: 06/04/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND To reduce recurrence or progression of tumor, NCCN guidelines recommend repeat transurethral resection of bladder tumors (reTURB) for non-muscle-invasive bladder cancer (NMIBC). The study aims to compare the impact of initial TURB and reTURB on the rate of residual or upstaging tumors and short-term and long-term survival outcomes of T1 bladder cancer (BC). MATERIALS AND METHODS We searched through several public database, including PubMed, Embase, Ovid Medline and Ovid EBM Reviews - Cochrane Central Register of Controlled Trials. The latest search time was October 2021. RESULTS In general, 68 articles were involved. Short-term RFS (1-year and 3-year) of reTURB group was better compared with TURB group in T1 patients. The pooled RR were 1.10 (95%CI: 1.01-1.19) and 1.15 (95%CI: 1.03-1.28), respectively. While reTURB did not improve long-term RFS (5-year, 10-year, 15-year) in T1 patients. The pooled RR were 1.12 (95%CI: 0.97-1.30), 1.11 (95%CI: 0.82-1.50) and 1.37 (95%CI: 0.50-3.74), respectively. Analysis of PFS, OS and CSS demonstrated similar outcomes with RFS. We found that about two-thirds of samples contained detrusor. The residual tumor rate in stage T1 was 0.48 (95%CI: 0.42-0.53). While the rate of upstaging in stage T1 was 0.10 (95%CI: 0.07-0.13). CONCLUSIONS In conclusion, reTURB might provide short-term survival benefits for T1 BC, but it was not the same for long-term outcomes. The residual and upstaging rates of T1 BC in reTURB were around 50% and 10%, respectively. Our study might be conducive to clinically informed consents when patients expressed their concerns about the necessity of reTURB and its impact on diagnosis, treatment and prognosis.
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Affiliation(s)
- Lede Lin
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaotong Guo
- Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yucheng Ma
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiang Zhu
- Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Xiang Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Musat MG, Kwon CS, Masters E, Sikirica S, Pijush DB, Forsythe A. Treatment Outcomes of High-Risk Non-Muscle Invasive Bladder Cancer (HR-NMIBC) in Real-World Evidence (RWE) Studies: Systematic Literature Review (SLR). Clinicoecon Outcomes Res 2022; 14:35-48. [PMID: 35046678 PMCID: PMC8759992 DOI: 10.2147/ceor.s341896] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/18/2021] [Indexed: 12/30/2022]
Abstract
Background To date, there has been limited synthesis of RWE studies in high-risk non-muscle invasive bladder cancer (HR-NMIBC). The objective of this research was to conduct a systematic review of published real-world evidence to better understand the real-world burden and treatment patterns in HR-NMIBC. Methods An SLR was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with the scope defined by the Population, Intervention Comparators, Outcomes, and Study design (PICOS) criteria. EMBASE, MEDLINE, and Cochrane databases (Jan 2015–Jul 2020) were searched, and relevant congress abstracts (Jan 2018–Jul 2020) identified. The final analysis only included studies that enrolled ≥100 patients with HR-NMIBC from the US, Europe, Canada, and Australia. Results The SLR identified 634 RWE publications in NMIBC, of which 160 studies reported data in HR-NMIBC. The average age of patients in the studies was 71 years, and 79% were males. The rates of BCG intravesical instillations ranged from 3% to 86% (29–95% for induction and 8–83% for maintenance treatment). Five-year outcomes were 17–89% recurrence-free survival (longest survival in patients completing BCG maintenance), 58–89% progression-free survival, 71–96% cancer-specific survival (lowest survival in BCG-unresponsive patients), and 28–90% overall survival (lowest survival in patients who did not receive BCG or instillation therapy). Conclusion BCG treatment rates and survival outcomes in patients with HR-NMIBC vary in the real world, with better survival seen in patients completing maintenance BCG, responding to treatment, and not progressing to muscle-invasive disease. There is a need to better understand the factors associated with BCG use and discontinuation and for an effective treatment that improves outcomes in HR-NMIBC. Generalization of these results is limited by variations in data collection, reporting, and methodologies used across RWE studies.
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Affiliation(s)
- Mihaela Georgiana Musat
- Evidence Generation, Purple Squirrel Economics, a Wholly Owned Subsidiary of Cytel, Inc., Waltham, MA, USA
| | - Christina Soeun Kwon
- Evidence Generation, Purple Squirrel Economics, a Wholly Owned Subsidiary of Cytel, Inc., Waltham, MA, USA
| | | | - Slaven Sikirica
- Global Health Economics and Outcomes Research, Pfizer, New York, NY, USA
| | - Debduth B Pijush
- Global Health Economics and Outcomes Research, Pfizer, New York, NY, USA
| | - Anna Forsythe
- Value and Access, Purple Squirrel Economics, a Wholly Owned Subsidiary of Cytel, Inc., Waltham, MA, USA
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Downes MR, Lajkosz K, Kuk C, Gao B, Kulkarni GS, van der Kwast TH. The impact of grading scheme on non-muscle invasive bladder cancer progression: potential utility of hybrid grading schemes. Pathology 2022; 54:425-433. [PMID: 35074179 DOI: 10.1016/j.pathol.2021.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/04/2021] [Accepted: 10/11/2021] [Indexed: 12/31/2022]
Abstract
Non-muscle invasive bladder cancer (NMIBC) grade is a major determinant of progression risk. The most widely utilised grading systems are the World Health Organization (WHO) 1973 and 2004 schemes. Recent publications suggest the utility of combining both into a four-tier or a hybrid three-tier system, subdividing WHO 2004 high grade into two separate categories while maintaining low grade as a single group. We identified two retrospective cohorts of bladder resections/biopsies of papillary urothelial NMIBC with long term clinical follow-up. The sentinel specimen was assessed for WHO 2004 and 1973 grade, along with pathological stage and carcinoma in situ. Each case was additionally stratified into a hybrid three-tier system (low grade; high grade, grades 2 and 3) and a four-tier system (low grade, grades 1 and 2; high grade, grades 2 and 3). Uni- and multivariable analysis for progression and event free survival (PFS/EFS) were calculated along with the time dependent area under the curve (AUC) for each grading scheme. There were 609 cases (Cohort A, n=343; Cohort B, n=266), including 449 (74%) pTa, 156 pT1 (26%) and four pTx with 338 (56%) low grade (177, grade 1; 161, grade 2) and 271 (44%) high grade (137, grade 2; 134, grade 3). A total of 108 patients progressed (17.7%): 97 high grade, (grade 3, n=59; grade 2, n=38). Multivariable analyses of PFS with the hybrid 3- and 4-tier systems showed higher Harrell's concordance indices (0.851 and 0.853, respectively) than WHO 1973 (0.844) and WHO 2004 (0.846). In both cohorts AUC values were higher (0.77-0.85) for the two hybrid grading systems compared to WHO 1973 or WHO 2004 (0.72-0.82). Similar results were seen on analysis of EFS. The data support the use of a hybrid three-tier or four-tier grading system to improve stratification of NMIBC patients.
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Affiliation(s)
- Michelle R Downes
- Division of Anatomic Pathology, Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
| | - Katherine Lajkosz
- Division of Urology, Department of Surgery and Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada
| | - Cynthia Kuk
- Division of Urology, Department of Surgery and Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada; Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - Bruce Gao
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada
| | - Girish S Kulkarni
- Division of Urology, Department of Surgery and Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada
| | - Theodorus H van der Kwast
- Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
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Reis LO, Dal Col LSB, Capibaribe DM, de Mendonça GB, Denardi F, Billis A. Presence and predominance of histological grade 3 define cT1HG bladder cancer prognostic groups. Investig Clin Urol 2022; 63:21-26. [PMID: 34983119 PMCID: PMC8756148 DOI: 10.4111/icu.20210386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/17/2021] [Accepted: 11/07/2021] [Indexed: 12/09/2022] Open
Abstract
PURPOSE Current World Health Organization/International Society of Urological Pathology (2004 WHO/ISUP) grading of bladder urothelial carcinoma relies on the highest pathologic grade of the specimen and does not reflect the inherent qualitative and quantitative heterogeneity of disease. MATERIALS AND METHODS We retrospectively studied consecutive urothelial high-grade cT1 (cT1HG) carcinomas submitted to adjuvant bacille Calmette-Guérin between 2008 and 2015 to evaluate the prognostic potential of grade 3 (presence or predominance) according to the 1973 WHO system concerning disease progression and cancer-specific death. RESULTS Among 253 patients, grading distribution was 34.4% 1+2, 7.5% 2+1, 20.2% 2+2, 19.0% 2+3, 5.1% 3+2, and 13.8% 3+3. Recurrence was diagnosed in 115 (45.5%), progression in 83 (32.8%), and cancer-specific death in 50 patients (19.8%). Mean time to recurrence, progression, and death from disease were 35.9±31.7, 47.6±44.5, and 51.2±50.4 months, respectively. Grade 3 presence (2+3, 3+2, or 3+3) occurred in 96 (37.9%) and independently predicted time to progression (p<0.001; hazard ratio [HR], 3.11; 95% confidence interval [CI], 1.88-5.14). Grade 3 predominance (3+2 or 3+3) occurred in 48 (18.9%) and independently predicted time to disease-specific death. CONCLUSIONS Grade 3 presence and predominance are independent predictors of progression and disease-specific death and occur in about 40% and 20% of cT1HG, respectively. Describing qualitative and quantitative heterogeneity in urothelial carcinoma grading might improve the stratification of patients. This gives three prognostic high-grade groups based on WHO/ISUP 1973: prognostic grade group I (grade 3 absence), prognostic grade group II (grade 3 presence), and prognostic grade group III (grade 3 predominance).
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Affiliation(s)
- Leonardo Oliveira Reis
- Division of Unicamp and Uro-Oncology, Department of UroScience Laboratory and Pathology, Pontifical Catholic University of Campinas, PUC-Campinas, São Paulo, Brazil.
| | - Luciana S B Dal Col
- Division of Unicamp and Uro-Oncology, Department of UroScience Laboratory and Pathology, Pontifical Catholic University of Campinas, PUC-Campinas, São Paulo, Brazil
| | - Diego M Capibaribe
- Division of Unicamp and Uro-Oncology, Department of UroScience Laboratory and Pathology, Pontifical Catholic University of Campinas, PUC-Campinas, São Paulo, Brazil
| | - Gustavo B de Mendonça
- Division of Unicamp and Uro-Oncology, Department of UroScience Laboratory and Pathology, Pontifical Catholic University of Campinas, PUC-Campinas, São Paulo, Brazil
| | - Fernandes Denardi
- Division of Unicamp and Uro-Oncology, Department of UroScience Laboratory and Pathology, Pontifical Catholic University of Campinas, PUC-Campinas, São Paulo, Brazil
| | - Athanase Billis
- Division of Unicamp and Uro-Oncology, Department of UroScience Laboratory and Pathology, Pontifical Catholic University of Campinas, PUC-Campinas, São Paulo, Brazil
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Asimakopoulos AD, Colalillo G, Telesca R, Mauriello A, Miano R, Di Stasi SM, Germani S, Finazzi Agrò E, Petrozza V, Caruso G, Carbone A, Pastore AL, Fuschi A. T1 Bladder Cancer: Comparison of the Prognostic Impact of Two Substaging Systems on Disease Recurrence and Progression and Suggestion of a Novel Nomogram. Front Surg 2021; 8:704902. [PMID: 34497827 PMCID: PMC8419324 DOI: 10.3389/fsurg.2021.704902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The T1 substaging of bladder cancer (BCa) potentially impacts disease progression. The objective of the study was to compare the prognostic accuracy of two substaging systems on the recurrence and progression of primary pathologic T1 (pT1) BCa and to test a nomogram based on pT1 substaging for predicting recurrence-free survival (RFS) and progression-free survival (PFS). Methods: The medical records of 204 patients affected by pT1 BCa were retrospectively reviewed. Substaging was defined according to the depth of lamina propria invasion in T1a-c and the extension of the lamina propria invasion to T1-microinvasive (T1m) or T1-extensive (T1e). Uni- and multivariable Cox regression models evaluated the independent variables correlated with recurrence and progression. The predictive accuracies of the two substaging systems were compared by Harrell's C index. Multivariate Cox regression models for the RFS and PFS were also depicted by a nomogram. Results: The 5-year RFS was 47.5% with a significant difference between T1c and T1a (p = 0.02) and between T1e and T1m (p < 0.001). The 5-year PFS was 75.9% with a significant difference between T1c and T1a (p = 0.011) and between T1e and T1m (p < 0.001). Model T1m-e showed a higher predictive power than T1a-c for predicting RFS and PFS. In the univariate and multivariate model subcategory T1e, the diameter, location, and number of tumors were confirmed as factors influencing recurrence and progression after adjusting for the other variables. The nomogram incorporating the T1m-e model showed a satisfactory agreement between model predictions at 5 years and actual observations. Conclusions: Substaging is significantly associated with RFS and PFS for patients affected by T1 BCa and should be included in innovative prognostic nomograms.
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Affiliation(s)
| | - Gaia Colalillo
- Division of Urology, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Rossana Telesca
- Pathology, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Alessandro Mauriello
- Pathology, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Roberto Miano
- Division of Urology, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Savino Mauro Di Stasi
- Division of Urology, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Stefano Germani
- Division of Urology, Fondazione PTV Policlinico Tor Vergata, Rome, Italy
| | - Enrico Finazzi Agrò
- Division of Urology, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Vincenzo Petrozza
- Pathology, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Gianluca Caruso
- Pathology, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Antonio Carbone
- Urology Unit ICOT, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
| | - Antonio Luigi Pastore
- Urology Unit ICOT, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
| | - Andrea Fuschi
- Urology Unit ICOT, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
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van Rhijn BWG, Hentschel AE, Bründl J, Compérat EM, Hernández V, Čapoun O, Bruins HM, Cohen D, Rouprêt M, Shariat SF, Mostafid AH, Zigeuner R, Dominguez-Escrig JL, Burger M, Soukup V, Gontero P, Palou J, van der Kwast TH, Babjuk M, Sylvester RJ. Prognostic Value of the WHO1973 and WHO2004/2016 Classification Systems for Grade in Primary Ta/T1 Non-muscle-invasive Bladder Cancer: A Multicenter European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel Study. Eur Urol Oncol 2021; 4:182-191. [PMID: 33423944 DOI: 10.1016/j.euo.2020.12.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/23/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND In the current European Association of Urology (EAU) non-muscle-invasive bladder cancer (NMIBC) guideline, two classification systems for grade are advocated: WHO1973 and WHO2004/2016. OBJECTIVE To compare the prognostic value of these WHO systems. DESIGN, SETTING, AND PARTICIPANTS Individual patient data for 5145 primary Ta/T1 NMIBC patients from 17 centers were collected between 1990 and 2019. The median follow-up was 3.9 yr. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Univariate and multivariable analyses of WHO1973 and WHO2004/2016 stratified by center were performed for time to recurrence, progression (primary endpoint), cystectomy, and duration of survival, taking into account age, concomitant carcinoma in situ, gender, multiplicity, tumor size, initial treatment, and tumor stage. Harrell's concordance (C-index) was used for prognostic accuracy of classification systems. RESULTS AND LIMITATIONS The median age was 68 yr; 3292 (64%) patients had Ta tumors. Neither classification system was prognostic for recurrence. For a four-tier combination of both WHO systems, progression at 5-yr follow-up was 1.4% in low-grade (LG)/G1, 3.8% in LG/G2, 7.7% in high grade (HG)/G2, and 18.8% in HG/G3 (log-rank, p < 0.001). In multivariable analyses with WHO1973 and WHO2004/2016 as independent variables, WHO1973 was a significant prognosticator of progression (p < 0.001), whereas WHO2004/2016 was not anymore (p = 0.067). C-indices for WHO1973, WHO2004, and the WHO systems combined for progression were 0.71, 0.67, and 0.73, respectively. Prognostic analyses for cystectomy and survival showed results similar to those for progression. CONCLUSIONS In this large prognostic factor study, both classification systems were prognostic for progression but not for recurrence. For progression, the prognostic value of WHO1973 was higher than that of WHO 2004/2016. The four-tier combination (LG/G1, LG/G2, HG/G2, and HG/G3) of both WHO systems proved to be superior, as it divides G2 patients into two subgroups (LG and HG) with different prognoses. Hence, the current EAU-NMIBC guideline recommendation to use both WHO classification systems remains correct. PATIENT SUMMARY At present, two classification systems are used in parallel to grade non-muscle-invasive bladder tumors. Our data on a large number of patients showed that the older classification system (WHO1973) performed better in terms of assessing progression than the more recent (WHO2004/2016) one. Nevertheless, we conclude that the current guideline recommendation for the use of both classification systems remains correct, since this has the advantage of dividing the large group of WHO1973 G2 patients into two subgroups (low and high grade) with different prognoses.
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Affiliation(s)
- Bas W G van Rhijn
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany; Surgical Oncology (Urology), University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, Canada.
| | - Anouk E Hentschel
- Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Urology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Johannes Bründl
- Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Eva M Compérat
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Pathology, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
| | - Virginia Hernández
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Otakar Čapoun
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czech Republic
| | - H Maxim Bruins
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Daniel Cohen
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, Royal Free London - NHS Foundation Trust, Royal Free Hospital, London, UK
| | - Morgan Rouprêt
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, Pitié Salpétrière Hospital, AP-HP, GRC n°5, ONCOTYPE-URO, Sorbonne University, Paris, France
| | - Shahrokh F Shariat
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, Teaching Hospital Motol and 2nd Faculty of Medicine, Charles University Praha, Prague, Czech Republic; Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - A Hugh Mostafid
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, The Stokes Centre for Urology, Royal Surrey Hospital, Guildford, UK
| | - Richard Zigeuner
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, Medical University of Graz, Graz, Austria
| | - Jose L Dominguez-Escrig
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, Fundación Instituto Valenciano de Oncología (I.V.O.), Valencia, Spain
| | - Maximilian Burger
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Viktor Soukup
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czech Republic
| | - Paolo Gontero
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy
| | - Joan Palou
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, Fundacio Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Theo H van der Kwast
- Laboratory Medicine Program, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, Canada
| | - Marko Babjuk
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, Teaching Hospital Motol and 2nd Faculty of Medicine, Charles University Praha, Prague, Czech Republic; Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - Richard J Sylvester
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
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10
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Mariappan P, Fineron P, O'Donnell M, Gailer RM, Watson DJ, Smith G, Grigor KM. Combining two grading systems: the clinical validity and inter-observer variability of the 1973 and 2004 WHO bladder cancer classification systems assessed in a UK cohort with 15 years of prospective follow-up. World J Urol 2020; 39:425-431. [PMID: 32266509 PMCID: PMC7910375 DOI: 10.1007/s00345-020-03180-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/23/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Paucity of reliable long-term data on the prognostic implications of the 2004 WHO bladder cancer classification system necessitates utilisation of both this and the 1973 grading systems. This study evaluated, in noninvasive (pTa) bladder tumours, the prognostic value of the 2004 system independently and in combination with the 1973 system while establishing concordance between tertiary centre uropathologists. Methods We used a cohort of non-muscle invasive bladder cancer (NMIBC) patients diagnosed between 1991 and 93 where tumour features were gathered prospectively with detailed cystoscopic follow-up data recorded over 15 years. Initial grading was by one senior expert uropathologist (UP1) using the 1973 WHO classification alone. Subsequently, two other expert uropathologists (UP2 and UP3), blinded to the previous grading, re-evaluated the pathology slides and graded the tumours using both the 1973 and 2004 systems. Association between grade and recurrence/progression was analysed and the Cohen Kappa test assessed concordance between pathologists. Results Of 370 new NMIBC, 229 were staged noninvasive (pTa). Recurrence rates were 46.2% and 50.0% for LGPUC (low-grade papillary urothelial carcinoma) and HGPUC (high-grade papillary urothelial carcinoma), respectively, while progression was seen in 3.9% and 10.0% of LGPUC and HGPUC, respectively. Concordance between uropathologists UP2 and UP3 for the 2004 and 1973 systems was good (Kappa = 0.69) and fair (Kappa = 0.25), respectively. Conclusions With good inter-observer concordance, the 2004 WHO classification system of noninvasive bladder tumours appears to accurately predict recurrence and progression risks. The combination of both grading systems to low-grade tumours allows further refinement of the natural history.
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Affiliation(s)
- Paramananthan Mariappan
- Edinburgh Urological Cancer Group, Department of Urology, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK. .,University of Edinburgh, Edinburgh, UK.
| | - Paul Fineron
- Department of Pathology, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - Marie O'Donnell
- Department of Pathology, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - Ruth M Gailer
- Edinburgh Urological Cancer Group, Department of Urology, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK
| | - David J Watson
- Edinburgh Urological Cancer Group, Department of Urology, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK
| | - Gordon Smith
- Edinburgh Urological Cancer Group, Department of Urology, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK
| | - Kenneth M Grigor
- University of Edinburgh, Edinburgh, UK.,Department of Pathology, Western General Hospital, Edinburgh, EH4 2XU, UK
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11
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Krajewski W, Rodríguez-Faba O, Breda A, Pisano F, Poletajew S, Tukiendorf A, Algaba F, Zdrojowy R, Kołodziej A, Palou J. The 1973 WHO and 2004 WHO grading systems are not equal in prediction of survival among stage T1 bladder cancer patients. Actas Urol Esp 2019; 43:467-473. [PMID: 31272800 DOI: 10.1016/j.acuro.2019.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/04/2019] [Accepted: 03/19/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND OBJECTIVES The aim of this study was to analyse prognostic impact of tumour histological grade on survival differences between primary G2 and G3 WHO1973 stage T1 tumours which were graded as HG according to WHO2004 grading system. MATERIALS AND METHODS Data from 481 patients with primary T1HG bladder cancer who were treated between 1986 and 2016 in 2university centres were retrospectively reviewed. Log-rank test and Cox regression analysis was performed to compare the groups. RESULTS 95 (19,8%) tumours were classified as G2 and 386 (80,2%) were G3. Median follow-up was 68 months. The recurrence was observed in 228 (47,5%), and progression in 109 patients (22,7%). Radical cystectomy was performed in 114 pts (23,7%) and there were 64 (13,3%) cancer specific deaths. Recurrence-free rates at 5-years follow-up for G2, G3 and all patients were 68,7%, 51,2% and 56,3% and progression-free rates were 89,3%, 73,2% and 78,1% respectively. For total observation period patients with G3 tumours presented also worse recurrence-free, and progression-free survival levels than patients with G2 tumours. In multivariate analysis, after adjustment for clinical features, the risk of recurrence and progression for G3 tumours was 1,65 and 2,42 fold higher than for G2 tumours. CONCLUSIONS It was shown that G3 T1 tumours are characterized by worse recurrence free and progression free survivals when compared to G2 cancers.
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12
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Guan B, Tang S, Zhan Y, Li Y, Fang D, Peng D, Gong Y, He S, Zhang L, Yang K, Xiong G, Liu L, He Q, Li X, Zhou L. Prognostic performance of the 1973 and 2004 WHO grading classification in upper tract urothelial carcinoma. Urol Oncol 2019; 37:529.e19-529.e25. [PMID: 31153747 DOI: 10.1016/j.urolonc.2019.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/03/2019] [Accepted: 01/13/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Grading of upper tract urothelial carcinoma (UTUC) is routinely used in clinical practice; however, reports concerning prognostic performance of different grading systems are contradictory. We aim to assess the clinical reliability of the 1973 and 2004 World Health Organization (WHO) grading classification systems in UTUC. PATIENTS AND METHODS We retrospectively evaluated 458 consecutive patients with UTUC from 2008 to 2013. The postoperative tumor grades were evaluated by a single uropathologist using the 1973 and 2004 WHO grade classification systems. The Kaplan-Meier method was used to estimate cancer-specific survival (CSS) and overall survival (OS). Univariate and multivariate analyses were used to test the association between clinical variables and the CSS and OS rates. RESULTS There were 133 (29.0%) low-grade patients and 325 (71.0%) high-grade patients. The 3-year CSS rates were 87.0% and 76.0% for G2 and G3 disease and 89.0% and 80.0% for low- and high-grade disease according to the 2004 system, respectively. For all UTUC patients, there were significant differences in the CSS and OS rates between G2 and G3 cases, as well as between the low- and high-grade groups. The CSS and OS rates were significantly different between the G2 and G3 cases for the overall high-grade population (CSS: P = 0.003; OS: P = 0.009), while no significant difference emerged between low- and high-grade tumors in G2 UTUC patients (CSS: P = 0.717; OS: P = 0.280). In the subgroup of high-grade non-muscle-invasive tumors, the 1973 WHO grading system was an independent predictor of CSS (P = 0.045). CONCLUSIONS The results support the hypothesis that the 1973 WHO system is superior to the 2004 system for predicting clinical outcomes in patients with non-muscle-invasive UTUC.
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Affiliation(s)
- Bao Guan
- Department of Urology, Peking University First Hospital, Xicheng, Beijing, China; Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Shiying Tang
- Department of Urology, Peking University First Hospital, Xicheng, Beijing, China; Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Yonghao Zhan
- Department of Urology, Peking University First Hospital, Xicheng, Beijing, China; Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Yifan Li
- Department of Urology, Peking University First Hospital, Xicheng, Beijing, China; Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Dong Fang
- Department of Urology, Peking University First Hospital, Xicheng, Beijing, China; Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Ding Peng
- Department of Urology, Peking University First Hospital, Xicheng, Beijing, China; Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Yanqing Gong
- Department of Urology, Peking University First Hospital, Xicheng, Beijing, China; Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Shiming He
- Department of Urology, Peking University First Hospital, Xicheng, Beijing, China; Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Lei Zhang
- Department of Urology, Peking University First Hospital, Xicheng, Beijing, China; Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Xicheng, Beijing, China; Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Gengyan Xiong
- Department of Urology, Peking University First Hospital, Xicheng, Beijing, China; Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Libo Liu
- Department of Urology, Peking University First Hospital, Xicheng, Beijing, China; Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China; Department of Pathology, Peking University First Hospital, Xicheng, Beijing, China
| | - Qun He
- Department of Urology, Peking University First Hospital, Xicheng, Beijing, China; Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China; Department of Pathology, Peking University First Hospital, Xicheng, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Xicheng, Beijing, China; Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China.
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Xicheng, Beijing, China; Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China.
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13
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Magers MJ, Lopez-Beltran A, Montironi R, Williamson SR, Kaimakliotis HZ, Cheng L. Staging of bladder cancer. Histopathology 2019; 74:112-134. [PMID: 30565300 DOI: 10.1111/his.13734] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/13/2018] [Accepted: 08/15/2018] [Indexed: 12/13/2022]
Abstract
Urothelial carcinoma of the urinary bladder is a heterogeneous disease with multiple possible treatment modalities and a wide spectrum of clinical outcome. Treatment decisions and prognostic expectations hinge on accurate and precise staging, and the recently published American Joint Committee on Cancer (AJCC) Staging Manual, 8th edition, should be the basis for staging of urinary bladder tumours. It is unfortunate that the International Union Against Cancer (UICC) 8th edition failed to incorporate new data which is considered in the AJCC 8th edition. Thus, the AJCC 8th edition is the focus of this review. Several critical changes and clarifications are made by the AJCC 8th edition relative to the 7th edition. Although the most obvious changes in the 8th edition are in the N (i.e. perivesical lymph node involvement now classified as N1) and M (i.e. M1 is subdivided into M1a and M1b) categories, several points are clarified in the T category (e.g. substaging of pT1 should be attempted). Further optimisation, however, is required. No particular method of substaging pT1 is formally recommended. In this review, these modifications are discussed, as well as points, which require further study and optimisation.
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Affiliation(s)
- Martin J Magers
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Antonio Lopez-Beltran
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Pathology, Cordoba, Spain
| | - Rodolfo Montironi
- Faculty of Medicine, Department of Surgery, Unit of Anatomical Pathology, Cordoba, Spain.,Champalimaud Clinical Center, Lisbon, Portugal
| | - Sean R Williamson
- Institute of Pathological Anatomy and Histopathology, School of Medicine, Polytechnic University of the Marche Region (Ancona), United Hospitals, Ancona, Italy.,Department of Pathology and Laboratory Medicine and Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, USA
| | | | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA
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14
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Elsawy AA, El-Assmy AM, Bazeed MA, Ali-El-Dein B. The value of immediate postoperative intravesical epirubicin instillation as an adjunct to standard adjuvant treatment in intermediate and high-risk non-muscle-invasive bladder cancer: A preliminary results of randomized controlled trial. Urol Oncol 2018; 37:179.e9-179.e18. [PMID: 30448030 DOI: 10.1016/j.urolonc.2018.10.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 09/16/2018] [Accepted: 10/16/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE We aimed at this study to test the value of immediate postoperative intravesical epirubicin instillation in intermediate and high-risk non-muscle-invasive bladder cancer patients. MATERIALS AND METHODS After approval of Institutional Review Board, 260 patients were randomly allocated into 2 groups, including transurethral resection of bladder tumor (TURBT) alone in control group and TURBT plus immediate postoperative epirubicin (50 mg) in test group. Patients were monitored for postoperative complications. Adjuvant instillation therapy was administered according to risk categorization. Patients were followed every 3 months by cystourethroscopy and urine cytology. The primary end points were recurrence, progression, and/or death from cancer. RESULTS Of the 260 patients, 236 were eligible and followed for a mean of 29 months. The 2 study groups were comparable regarding perioperative baseline demographic criteria. There was no statistically significant difference between the 2 groups regarding recurrence rate (27.1% vs. 26.2%), interval to first recurrence (16.3 ± 6.6 vs. 16.4 ± 6.4 months) or progression rate to muscle invasion (8.5% vs. 5.9%). Site, size, and number of recurrences were also comparable between the 2 groups. Recurrences and progression-free survival were comparable between the 2 groups (Log-rank P = 0.88 and 0.47, respectively). Postoperative complications were all low-grade according to modified Dindo-Clavian system, with no significant difference in their rate between the 2 groups. CONCLUSIONS Immediate post-TURBT epirubicin instillation is ineffective in intermediate and high-risk non-muscle-invasive bladder cancer. It neither prolongs time to recurrence and/or progression nor reduces number of recurrences. We advocate strict specification of patient and tumor criteria in which immediate instillation is indicated.
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Affiliation(s)
- Amr A Elsawy
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
| | - Ahmed M El-Assmy
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mahmoud A Bazeed
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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15
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van de Putte EEF, Bosschieter J, van der Kwast TH, Bertz S, Denzinger S, Manach Q, Compérat EM, Boormans JL, Jewett MAS, Stoehr R, van Leenders GJLH, Nieuwenhuijzen JA, Zlotta AR, Hendricksen K, Rouprêt M, Otto W, Burger M, Hartmann A, van Rhijn BWG. The World Health Organization 1973 classification system for grade is an important prognosticator in T1 non-muscle-invasive bladder cancer. BJU Int 2018; 122:978-985. [PMID: 29637669 DOI: 10.1111/bju.14238] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES 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-BCs, initially managed conservatively (bacille Calmette-Guérin) in four hospitals. Grade was defined according to WHO1973 (Grade 1-3) and WHO2004 (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 WHO1973 Grade 3 was negatively associated with PFS (hazard ratio [HR] 2.1) and CSS (HR 3.4), whilst WHO2004 grade was not prognostic. On multivariable analysis, WHO1973 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 WHO1973 classification system for grade has strong prognostic value in T1-BC, compared to the WHO2004 system. Our present results suggest that WHO1973 grade cannot be replaced by the WHO2004 classification in non-muscle-invasive BC guidelines.
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Affiliation(s)
- Elisabeth E Fransen van de Putte
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Judith Bosschieter
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.,Department of Urology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Theo H van der Kwast
- Department of Pathology, Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, The Netherlands.,Department of Pathology, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Simone Bertz
- Department of Pathology, University of Erlangen, Erlangen, Germany
| | - Stefan Denzinger
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Quentin Manach
- Academic Department of Urology, Pitié-Salpétrière Hospital, Assistance-Publique Hôpitaux de Paris, Pierre et Marie Curie Medical School, University Paris, Paris, France
| | - Eva M Compérat
- Department of Pathology, Pitié-Salpétrière Hospital, Assistance-Publique Hôpitaux de Paris, Pierre et Marie Curie Medical School, University Paris, Paris, France
| | - Joost L Boormans
- Department of Urology, Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Michael A S Jewett
- Department of Surgical Oncology (Urology), Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Robert Stoehr
- Department of Pathology, University of Erlangen, Erlangen, Germany
| | | | | | - Alexandre R Zlotta
- Department of Surgical Oncology (Urology), Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada.,Department of Urology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Kees Hendricksen
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Morgan Rouprêt
- Academic Department of Urology, Pitié-Salpétrière Hospital, Assistance-Publique Hôpitaux de Paris, Pierre et Marie Curie Medical School, University Paris, Paris, France
| | - Wolfgang Otto
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Arndt Hartmann
- Department of Pathology, University of Erlangen, Erlangen, Germany
| | - Bas W G van Rhijn
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.,Department of Urology, Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, The Netherlands.,Department of Surgical Oncology (Urology), Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada.,Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
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16
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Colombo R, Hurle R, Moschini M, Freschi M, Colombo P, Colecchia M, Ferrari L, Lucianò R, Conti G, Magnani T, Capogrosso P, Conti A, Pasini L, Burgio G, Guazzoni G, Patriarca C. Feasibility and Clinical Roles of Different Substaging Systems at First and Second Transurethral Resection in Patients with T1 High-Grade Bladder Cancer. Eur Urol Focus 2018; 4:87-93. [DOI: 10.1016/j.euf.2016.06.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/13/2016] [Accepted: 06/06/2016] [Indexed: 10/21/2022]
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17
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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. Eur Urol 2017; 72:801-813. [DOI: 10.1016/j.eururo.2017.04.015] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 04/12/2017] [Indexed: 12/13/2022]
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18
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Prognostic Value of Gene Methylation and Clinical Factors in Non–Muscle-Invasive Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy. Clin Genitourin Cancer 2016; 14:e371-8. [DOI: 10.1016/j.clgc.2016.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 01/27/2016] [Accepted: 02/14/2016] [Indexed: 01/13/2023]
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19
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Patschan O, Sjödahl G, Chebil G, Lövgren K, Lauss M, Gudjonsson S, Kollberg P, Eriksson P, Aine M, Fernö M, Liedberg F, Höglund M. Reply from Authors re: Bas W.G. van Rhijn, Mark A. Behrendt, Kees Hendricksen, Theo H. van der Kwast. Toward Optimal Prediction of Prognosis in T1 Urothelial Carcinoma of the Bladder. Eur Urol 2015;68:833–4. Eur Urol 2015. [DOI: 10.1016/j.eururo.2015.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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