1
|
Malm C, Grahn A, Jaremko G, Tribukait B, Brehmer M. Diagnostic accuracy of upper tract urothelial carcinoma: how samples are collected matters. Scand J Urol 2017; 51:137-145. [DOI: 10.1080/21681805.2017.1295102] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Camilla Malm
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Alexandra Grahn
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Georg Jaremko
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Bernhard Tribukait
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Marianne Brehmer
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
2
|
Koyuncuer A. Histopathologic Evolution of Urothelial Carcinoma Recurrence in Transurethral Resection of the Urinary Bladder:35 Consecutive Cases And Literature Review. Asian Pac J Cancer Prev 2017; 18:459-463. [PMID: 28345830 PMCID: PMC5454743 DOI: 10.22034/apjcp.2017.18.2.459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Urothelial carcinoma (UC) is the malignancy most frequently encountered in the urinary bladder. The primary aim of this study was to make a reappraisal of histopathologic features, recurrence and progression. Materials and Methods: The records of cases consecutively diagnosed with UC in the state hospital pathology laboratory were collected. Cases were classified according to age, gender, histologic grade, pathologic staging [primary Tumor (pT)],tumor configuration, primary or recurrent status, and progression. Results: A total of 35 (29 male and 6 female) cases were examined. The mean age was 68.9 years with a male-to-female incidence ratio of 4.8:1. Low-grade UCs accounted for 20 (57.1%) and high-grade for 15 (42.9%). A papillary pattern was observed in 80% of the UCs, classified into the following pathological stages: 11 (31.4%) pTa, 22 (62.9%) pT1, and 2 (5.9%) pT2 cases. Eleven patients progressed to a higher stage (pT1 to pT2), and three cases from low to higher grade. We analyzed results for 26 (74.3%) cases aged 65 years or older. Conclusions: UCs have a great tendency for recurrence but potentially may be amenable to effective local or systemic treatments.
Collapse
Affiliation(s)
- Ali Koyuncuer
- Department of Pathology, Antakya State Hospital, Hatay, Turkey.
| |
Collapse
|
3
|
Karaarslan S, Yaman B, Ozturk H, Kumbaraci BS. Parafibromin Staining Characteristics in Urothelial Carcinomas and Relationship with Prognostic Parameters. J Pathol Transl Med 2015; 49:389-95. [PMID: 26395176 PMCID: PMC4579279 DOI: 10.4132/jptm.2015.08.10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 08/05/2015] [Accepted: 08/10/2015] [Indexed: 01/01/2023] Open
Abstract
Background: Parafibromin is a recently defined tumor suppressor gene. The aim of our study was to determine the relationships of parafibromin expression in urothelial carcinomas (UCs) with prognostic parameters and to evaluate the use of parafibromin as a potential marker of UC. Methods: Parafibromin expression was assessed in 49 UC specimens using immunohistochemistry. The correlations between parafibromin expression and clinical and pathologic parameters were investigated. Results: Of the patients, 42 (85.7%) were male, and the mean age was 69.6 ± 8.2 years (range, 54 to 88 years). Morphologically, the UCs were divided into two groups: papillary (n = 27) and non-papillary (n = 22). There were seven low-grade (14.3%) and 42 high-grade (85.7%) tumors. Parafibromin was negative in 13 tumors (26.5%), partially positive in 19 tumors (38.8%), and positive in 17 tumors (34.7%). Parafibromin expression was more negative in UCs from upper urinary locations (n=17) and with muscularis propria invasion (n=28), which was statistically significant (p = .009 and p = .007, respectively). There was no statistically significant relationship between parafibromin expression and gender, age, tumor grade, survival, or disease-free survival. Conclusions: We found that UC cases with parafibromin positivity had less of a tendency to show muscularis propria invasion and were more commonly located in the lower urinary system. These results need to be confirmed with studies based on larger case series.
Collapse
Affiliation(s)
- Serap Karaarslan
- Department of Pathology, Sifa University Faculty of Medicine, Izmir, Turkey
| | - Banu Yaman
- Department of Pathology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Hakan Ozturk
- Department of Urology, Sifa University Faculty of Medicine, Izmir, Turkey
| | | |
Collapse
|
4
|
Koyuncuer A. Histopathological evaluation of urothelial carcinomas in transurethral resection urinary bladder tumor specimens: eight years of single center experience. Asian Pac J Cancer Prev 2015; 16:2871-7. [PMID: 25854375 DOI: 10.7314/apjcp.2015.16.7.2871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Urothelial carcinoma (UC) is a malignant neoplasm that most commonly occurs in the urinary bladder. The primary aim of this study was to evaluate the clinicopathologic features, recurrence and progression in patients with bladder urothelial cancer. MATERIALS AND METHODS The medical records of patients diagnosed with UC in the state pathology laboratory between January 2006 and July 2014 were retrospectively included. Carcinomas were categorized according to age, gender, histologic grade, tumor configuration, pathologic staging, recurrence status, and progression. RESULTS A total of 125 (113 men, 12 women) patients were examined. The mean age was 65.9 years and the male-to-female urothelial cancer incidence ratio was 9.4:1. Low-grade UCs were observed in 85 (68%) and high-grade in 40 (32%). A papillary tumor pattern was observed in 67.2% of the UCs. Cases were classified with the following pathological grades: 34 (27.2%) cases of pTa, 70 (56%) of pT1, and 21 (16.8%) of pT2. Recurrence occurred in 27 (21.6%) patients. Ten progressed to a higher stage (pT1 to pT2), and three cases to higher grade (low to high). We also analyzed the results separately for 70 (56%) patients 65 years of age and older. CONCLUSIONS With early detection and diagnosis of precursor lesions in older patients, by methods such as standard urologic evaluation, urinary cytology, ultrasound scanning and contrast urography, and cystoscopy, in addition to coordinated efforts between pathologists and urologists, early diagnosis may reduce the morbidity and mortality of patients with urothelial carcinoma.
Collapse
Affiliation(s)
- Ali Koyuncuer
- Department of Pathology, State Hospital, Antakya, Hatay, Turkey E-mail :
| |
Collapse
|
5
|
Cheng L, MacLennan GT, Lopez-Beltran A. Histologic grading of urothelial carcinoma: a reappraisal. Hum Pathol 2012; 43:2097-108. [DOI: 10.1016/j.humpath.2012.01.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 01/11/2012] [Accepted: 01/13/2012] [Indexed: 10/28/2022]
|
6
|
Balog J, Szaniszlo T, Schaefer KC, Denes J, Lopata A, Godorhazy L, Szalay D, Balogh L, Sasi-Szabo L, Toth M, Takats Z. Identification of biological tissues by rapid evaporative ionization mass spectrometry. Anal Chem 2011; 82:7343-50. [PMID: 20681559 DOI: 10.1021/ac101283x] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The newly developed rapid evaporative ionization mass spectrometry (REIMS) provides the possibility of in vivo, in situ mass spectrometric tissue analysis. The experimental setup for REIMS is characterized in detail for the first time, and the description and testing of an equipment capable of in vivo analysis is presented. The spectra obtained by various standard surgical equipments were compared and found highly specific to the histological type of the tissues. The tissue analysis is based on their different phospholipid distribution; the identification algorithm uses a combination of principal component analysis (PCA) and linear discriminant analysis (LDA). The characterized method was proven to be sensitive for any perturbation such as age or diet in rats, but it was still perfectly suitable for tissue identification. Tissue identification accuracy higher than 97% was achieved with the PCA/LDA algorithm using a spectral database collected from various tissue species. In vivo, ex vivo, and post mortem REIMS studies were performed, and the method was found to be applicable for histological tissue analysis during surgical interventions, endoscopy, or after surgery in pathology.
Collapse
|
7
|
Gonul II, Poyraz A, Unsal C, Acar C, Alkibay T. Comparison of 1998 WHO/ISUP and 1973 WHO classifications for interobserver variability in grading of papillary urothelial neoplasms of the bladder. Pathological evaluation of 258 cases. Urol Int 2007; 78:338-44. [PMID: 17495493 DOI: 10.1159/000100839] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Accepted: 08/16/2006] [Indexed: 11/19/2022]
Abstract
AIM Our aim was to compare the interobserver variability between the 1998 WHO/ISUP and 1973 WHO classifications. METHODS 258 consecutive papillary urothelial carcinomas were reviewed by two pathologists and assigned a tumor grade according to the 1973 WHO and 1998 WHO/ISUP without the knowledge of primary diagnosis and clinical follow-up. All cases were also histologically staged by the two pathologists separately as follows: pTa (noninvasive), pT1 (lamina propria invasion only), pT2 (muscularis propria invasion). Findings of both pathologists and degree of agreement were compared statistically by using Pearson's chi(2) test and kappa statistics respectively. A kappa value of 0.21-0.40 is accepted as fair, 0.41-0.60 moderate and 0.61-0.80 substantial agreement. RESULTS Regardless of the pathologist, tumor grades of two classifications correlated to each other and the pathological stage (p < 0.05). Overall degree of agreement between pathologists was higher in the 1998 WHO/ISUP (kappa 0.59) than the 1973 WHO (kappa 0.41), but both were still moderate. Papillary urothelial neoplasia with low malignant potential was the group of 1998 WHO/ISUP that showed the lowest degree of agreement and if excluded, interobserver variability of the 1998 WHO/ISUP decreased significantly (kappa 0.84). CONCLUSION The diagnosis of papillary urothelial neoplasia with low malignant potential and the criteria that differentiates it from low-grade carcinomas needs improvement in order to compare the different studies and therapies and to provide more accurate information for management.
Collapse
Affiliation(s)
- Ipek Işik Gonul
- Department of Pathology, Gazi University Medical School, Ankara, Turkey.
| | | | | | | | | |
Collapse
|
8
|
Genega EM, Kapali M, Torres-Quinones M, Huang WC, Knauss JS, Wang LP, Raghunath PN, Kozlowski C, Malkowicz SB, Tomaszewski JE. Impact of the 1998 World Health Organization/International Society of Urological Pathology classification system for urothelial neoplasms of the kidney. Mod Pathol 2005; 18:11-8. [PMID: 15475938 DOI: 10.1038/modpathol.3800268] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The classification of urothelial neoplasms of the kidney traditionally has been similar to that of urinary bladder tumors. Several years ago, the classification of papillary urothelial neoplasms was revised. The current study focuses on the application of the 1998 World Health Organization (WHO)/International Society of Urological Pathology classification system to 102 renal pelvic urothelial neoplasms and compares it to the 1973 WHO classification scheme. In this study, all tumors were classified as urothelial carcinomas, and the majority (85%) were papillary. Most patients with papillary tumors presented with 'superficial' disease (< or = pT1). With the 1998 system, most papillary carcinomas were high grade, and were more often invasive as compared to low-grade tumors. Only 34% were low-grade papillary tumors and, of these, most (93%) were noninvasive. With the 1973 system, most papillary tumors were grade 2 or 3, with invasion more common in grade 3 tumors. By 1973 criteria, grade 2 tumors were a heterogeneous group; with 1998 criteria, nearly one-half were high grade and the other half low grade. The grade of papillary urothelial carcinomas with both the 1973 and 1998 grading methods was associated with stage (P=0.001). Our study reveals that papillomas and papillary urothelial neoplasms of low malignant potential are uncommon tumors in the kidney. Renal pelvic papillary urothelial neoplasms are most often carcinomas and are more commonly high grade than low grade. Although both the 1973 and 1998 systems showed a significant association with tumor stage, grade 2 papillary carcinomas are a heterogeneous group by 1973 criteria. The 1998 system provides useful information in that it more clearly defines a papillary tumor's grade and selects for a group of tumors, namely low-grade papillary urothelial carcinomas, for which a low likelihood of invasion can be predicted.
Collapse
Affiliation(s)
- Elizabeth M Genega
- Department of Pathology, University of Pennsylvania Medical Center, Philadelphia, PA, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Kordek R. Klasyfikacje nowotworów pęcherza moczowego. Rep Pract Oncol Radiother 2004. [DOI: 10.1016/s1507-1367(04)71025-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
10
|
Grönlund-Pakkanen S, Wahlfors J, Talja M, Kosma VM, Pakkanen TM, Ala-Opas M, Alhava E, Moore RB. The effect of photodynamic therapy on rat urinary bladder with orthotopic urothelial carcinoma. BJU Int 2003; 92:125-30. [PMID: 12823396 DOI: 10.1046/j.1464-410x.2003.04290.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the effect of whole-bladder photodynamic therapy (PDT) on a rat model with orthotopic superficial bladder cancer, as PDT is an alternative intravesical therapy for treating superficial bladder cancer, based on an interaction between a photosensitizer and light energy to induce oxygen radicals that destroy tissue by lipid peroxidation. MATERIALS AND METHODS In all, 76 female Fischer F344 rats were inoculated intravesically with AY-27 tumour cells. After establishing superficial tumour, 24 rats were treated with PDT using aminolaevulinic acid (ALA)-induced protoporphyrin IX as a photosensitizer, and a continuous-wave argon pumped-dye laser (638 nm). At 4 h after intravenous (300 mg/kg) or intravesical (100 mg/mL) administration of ALA the bladders were intravesically exposed to a 40 J/cm(2) light dose; 12 rats received no ALA but were exposed to the same light dose. Before administering ALA, urine cytology samples were taken for analysis. At 3 or 21 days the treated rats were killed and morphological changes in the bladder walls analysed by light microscopy. Forty rats served as controls to examine the presence of tumour. RESULTS The tumour established in 33 of 40 rats (83%) in the controls, but after PDT with intravesical ALA there was carcinoma in only in one of 12 (P < 0.001, Pearson's chi(2) test). After PDT with intravenous ALA there was carcinoma in five of 11 rats (P = 0.063, Pearson's chi2 test). In the control group of 12 rats receiving only light energy there was carcinoma in three (P = 0.001, Pearson's chi(2) test). Histologically, at 3 days after PDT there was only mild superficial damage in all six rats treated intravesically. Bladder wall destruction reached the muscular layer, with an abscess in one of six rats treated intravenously. After 3 weeks of PDT there was muscular necrosis with perforation and abscess from catheterization two of six rats treated intravesically and in three the bladder wall totally recovered. In the intravenous group the bladder walls were normal or had only mild superficial damage. Cytology of the urine sediment failed to detect half the tumours in the treatment groups. CONCLUSION These results support the use of PDT with intravesical ALA-induced protoporphyrin X for treating superficial bladder carcinoma. Intravesical was better than intravenous ALA in eradicating bladder carcinoma with PDT.
Collapse
|
11
|
Oosterhuis JWA, Schapers RFM, Janssen-Heijnen MLG, Pauwels RPE, Newling DW, ten Kate F. Histological grading of papillary urothelial carcinoma of the bladder: prognostic value of the 1998 WHO/ISUP classification system and comparison with conventional grading systems. J Clin Pathol 2002; 55:900-5. [PMID: 12461053 PMCID: PMC1769816 DOI: 10.1136/jcp.55.12.900] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIM To test the prognostic value of the 1998 WHO/ISUP (World Health Organisation/International Society of Urologic Pathology) consensus classification system in Ta papillary urothelial neoplasms of the bladder. METHODS The histological slides of 322 patients with a primary Ta tumour were classified according to the consensus classification system, and recurrence free survival (RFS) and progression free survival (PFS) were assessed for a mean follow up period of 79 months. In the same patient group, the RFS and PFS rates for the 1973 WHO grading system and a low grade/high grade system were analysed. RESULTS Recurrent tumours were seen in all categories of the 1998 WHO/ISUP classification system and five year RFS was not significantly different between the groups (p = 0.12). The five year PFS showed a small but significant difference (p = 0.04) between papillary neoplasms of low malignant potential (PNLMP) and high grade papillary urothelial carcinomas (HGPUCs). In the 1973 WHO classification, no significant difference was found in RFS and PFS between the different grades. In the low grade/high grade classification PFS was significantly better for low grade tumours (p = 0.01). CONCLUSION The prognostic value of the 1998 WHO/ISUP classification system is limited to predicting PFS, especially between PNLMP and HGPUC. The prognostic value of this system over other grading systems is questionable.
Collapse
Affiliation(s)
- J W A Oosterhuis
- Department of Pathology, Stichting Ziekenhuizen Noord-Limburg, PO Box 1926, 5900 BX, Venlo, The Netherlands.
| | | | | | | | | | | |
Collapse
|
12
|
Bol MGW, Baak JPA, Rep S, Marx WL, Kruse AJ, Bos SD, Kisman O, Voorhorst FJ. Prognostic value of proliferative activity and nuclear morphometry for progression in TaT1 urothelial cell carcinomas of the urinary bladder. Urology 2002; 60:1124-30. [PMID: 12475695 DOI: 10.1016/s0090-4295(02)01906-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To analyze the predictive power of Ki67 area% (Ki67), mitotic activity index (MAI), p53 area% (p53), and the mean area of the 10 largest nuclei (MNA10) for progression of stage in 195 primary consecutive TaT1 urothelial cell carcinomas of the urinary bladder. METHODS Ki67- and p53-positive versus negative nuclei, MAI, and MNA10 using motorized systematic random sampling morphometry were determined. Kaplan-Meier curves and multivariate survival analysis (Cox model) were used to assess the prognostic value of the quantitative and classic clinicopathologic risk factors (age, sex, stage, grade, carcinoma in situ, multicentricity). RESULTS Thirteen (6.7%) of the 195 patients had progression (0 [0%] of 36 low-risk, 1 [1.1%] of 85 intermediate-risk, and 12 [16.2%] of 74 high-risk patients). In univariate analysis (all variables), the strongest predictors with the highest hazard ratios were Ki67 (threshold 25.0%), MAI (threshold 30), and MNA10 (threshold 170 microm2). In multivariate analysis, the strongest independent combinations for progression--MNA10 (170 microm2) plus MAI (threshold 30) and MNA10 (threshold 170 microm2) plus Ki67 (threshold 25.0%)--overshadowed all other features. p53 was weaker but, combined with Ki67, still predicted progression fairly well. In the total group, the sensitivity, specificity, and positive and negative predictive values of MNA10-MAI and MNA10-Ki67 at the thresholds mentioned were 100%, 89%, 38%, and 100%, respectively. These feature combinations were also strongest prognostically in the high-risk treatment group. CONCLUSIONS The combined biomarkers MNA10-MAI or MNA10-Ki67 are accurate, well reproducible, and easy to assess progression predictors in all patients with TaT1 urothelial cell carcinomas, as well as in high-risk (bacille Calmette-Guérin-treated) patients.
Collapse
Affiliation(s)
- Marco G W Bol
- Department of Pathology, SIR Hospital, Stavanger, Norway
| | | | | | | | | | | | | | | |
Collapse
|
13
|
The Fluorescence Biodistribution And Kinetics Of Aminolevulinic Acid Induced Protoporphyrin IX In The Bladder Of A Rat Model With Orthotopic Urothelial Carcinoma. J Urol 2002. [DOI: 10.1097/00005392-200204000-00093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
14
|
The Fluorescence Biodistribution And Kinetics Of Aminolevulinic Acid Induced Protoporphyrin IX In The Bladder Of A Rat Model With Orthotopic Urothelial Carcinoma. J Urol 2002. [DOI: 10.1016/s0022-5347(05)65247-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
15
|
STAGE PROGRESSION IN TA PAPILLARY UROTHELIAL TUMORS: RELATIONSHIP TO GRADE, IMMUNOHISTOCHEMICAL EXPRESSION OF TUMOR MARKERS, MITOTIC FREQUENCY AND DNA PLOIDY. J Urol 2001. [DOI: 10.1097/00005392-200104000-00015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
16
|
HOLMÄNG STEN, ANDIUS PATRIK, HEDELIN HANS, WESTER KENNETH, BUSCH CHRISTER, JOHANSSON SONNYL. STAGE PROGRESSION IN TA PAPILLARY UROTHELIAL TUMORS: RELATIONSHIP TO GRADE, IMMUNOHISTOCHEMICAL EXPRESSION OF TUMOR MARKERS, MITOTIC FREQUENCY AND DNA PLOIDY. J Urol 2001. [DOI: 10.1016/s0022-5347(05)66443-9] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- STEN HOLMÄNG
- From the Department of Urology, Sahlgrenska University Hospital, Göteborg, Department of Urology, Kärnsjukhuset, Skövde and Department of Genetics and Pathology, Uppsala University, Uppsala, Sweden, and Department of Pathology, University Hospital, Tromsö, Norway, and Department of Pathology and Microbiology, and Eppley Institute of Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - PATRIK ANDIUS
- From the Department of Urology, Sahlgrenska University Hospital, Göteborg, Department of Urology, Kärnsjukhuset, Skövde and Department of Genetics and Pathology, Uppsala University, Uppsala, Sweden, and Department of Pathology, University Hospital, Tromsö, Norway, and Department of Pathology and Microbiology, and Eppley Institute of Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - HANS HEDELIN
- From the Department of Urology, Sahlgrenska University Hospital, Göteborg, Department of Urology, Kärnsjukhuset, Skövde and Department of Genetics and Pathology, Uppsala University, Uppsala, Sweden, and Department of Pathology, University Hospital, Tromsö, Norway, and Department of Pathology and Microbiology, and Eppley Institute of Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - KENNETH WESTER
- From the Department of Urology, Sahlgrenska University Hospital, Göteborg, Department of Urology, Kärnsjukhuset, Skövde and Department of Genetics and Pathology, Uppsala University, Uppsala, Sweden, and Department of Pathology, University Hospital, Tromsö, Norway, and Department of Pathology and Microbiology, and Eppley Institute of Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - CHRISTER BUSCH
- From the Department of Urology, Sahlgrenska University Hospital, Göteborg, Department of Urology, Kärnsjukhuset, Skövde and Department of Genetics and Pathology, Uppsala University, Uppsala, Sweden, and Department of Pathology, University Hospital, Tromsö, Norway, and Department of Pathology and Microbiology, and Eppley Institute of Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - SONNY L. JOHANSSON
- From the Department of Urology, Sahlgrenska University Hospital, Göteborg, Department of Urology, Kärnsjukhuset, Skövde and Department of Genetics and Pathology, Uppsala University, Uppsala, Sweden, and Department of Pathology, University Hospital, Tromsö, Norway, and Department of Pathology and Microbiology, and Eppley Institute of Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| |
Collapse
|
17
|
Van Der Meijden A, Sylvester R, Collette L, Bono A, Ten Kate F. The role and impact of pathology review on stage and grade assessment of stages Ta and T1 bladder tumors: a combined analysis of 5 European Organization for Research and Treatment of Cancer Trials. J Urol 2000; 164:1533-7. [PMID: 11025698 DOI: 10.1097/00005392-200011000-00017] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Pathological interpretations are largely subject to interpathologist and intrapathologist variation. Differences in tumor stage and grade exist in local and review pathological findings in patients with stage Ta-T1 bladder tumors who are entered in randomized trials of adjuvant treatment after transurethral resection. Because they are diagnosed and treated based on local pathological results, it is important to determine the reliability of local pathological evaluations and the extent to which pathology review may change the treatment decision process. MATERIALS AND METHODS We assessed local and review pathology results in 1,400 patients treated in 5 European Organization for Research and Treatment of Cancer randomized phase III trials comparing various adjuvant prophylactic treatment strategies for primary or recurrent stage Ta-T1 transitional cell bladder cancer. RESULTS We noted large variations in T category and grade. Pathology review down staged T category to stage Ta in 53% of cases originally classified as stage T1. There was agreement in only 57% and 50% of stage Ta grade 1 and stage T1 grade 3 cases, of which 10% were reclassified as muscle invasive disease greater than stage T1. While T category and grade have prognostic importance, differences in the prognosis based on local and review pathological studies were slight. CONCLUSIONS Pathology review is not mandatory in low and intermediate risk cases since it has little impact on the prognosis and treatment decision making. In high risk cases of stage T1 grade 3 disease stage or grade is often changed, so that review remains essential in this subgroup.
Collapse
Affiliation(s)
- A Van Der Meijden
- Bosch Medicentrum, 's Hertogenbosch and Academisch Medisch Centrum, Amsterdam, The Netherlands
| | | | | | | | | |
Collapse
|
18
|
VAN DER MEIJDEN A, SYLVESTER R, COLLETTE L, BONO A, TEN KATE F. THE ROLE AND IMPACT OF PATHOLOGY REVIEW ON STAGE AND GRADE ASSESSMENT OF STAGES TA AND T1 BLADDER TUMORS: A COMBINED ANALYSIS OF 5 EUROPEAN ORGANIZATION FOR RESEARCH AND TREATMENT OF CANCER TRIALS. J Urol 2000. [DOI: 10.1016/s0022-5347(05)67022-x] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- A. VAN DER MEIJDEN
- From the Bosch Medicentrum, ’s Hertogenbosch and Academisch Medisch Centrum, Amsterdam, The Netherlands, European Organization for Research and Treatment of Cancer Data Center, Brussels, Belgium, and Ospedale di Circolo e Fundazione Macchi, Varese, Italy
| | - R. SYLVESTER
- From the Bosch Medicentrum, ’s Hertogenbosch and Academisch Medisch Centrum, Amsterdam, The Netherlands, European Organization for Research and Treatment of Cancer Data Center, Brussels, Belgium, and Ospedale di Circolo e Fundazione Macchi, Varese, Italy
| | - L. COLLETTE
- From the Bosch Medicentrum, ’s Hertogenbosch and Academisch Medisch Centrum, Amsterdam, The Netherlands, European Organization for Research and Treatment of Cancer Data Center, Brussels, Belgium, and Ospedale di Circolo e Fundazione Macchi, Varese, Italy
| | - A. BONO
- From the Bosch Medicentrum, ’s Hertogenbosch and Academisch Medisch Centrum, Amsterdam, The Netherlands, European Organization for Research and Treatment of Cancer Data Center, Brussels, Belgium, and Ospedale di Circolo e Fundazione Macchi, Varese, Italy
| | - F. TEN KATE
- From the Bosch Medicentrum, ’s Hertogenbosch and Academisch Medisch Centrum, Amsterdam, The Netherlands, European Organization for Research and Treatment of Cancer Data Center, Brussels, Belgium, and Ospedale di Circolo e Fundazione Macchi, Varese, Italy
| |
Collapse
|
19
|
Oosterhuis JW, Schapers RF, Janssen-Heijnen ML, Smeets AW, Pauwels RP. MIB-1 as a proliferative marker in transitional cell carcinoma of the bladder: clinical significance and comparison with other prognostic factors. Cancer 2000; 88:2598-605. [PMID: 10861439 DOI: 10.1002/1097-0142(20000601)88:11<2598::aid-cncr24>3.0.co;2-n] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Staging and grading of transitional cell carcinoma of the bladder are generally viewed as indicators of prognosis and form the basis of therapy, but they do not predict outcome accurately. This study was designed to evaluate the value for predicting recurrence, progression, and survival of proliferation fraction in transitional cell carcinoma of the bladder determined by immunostaining of histopathologic specimens with the monoclonal antigen MIB-1. METHODS In a prospectively followed group of 301 patients with transitional cell carcinoma of the bladder, formalin fixed tumor specimens were immunostained and the MIB-1 labeling index was determined. Crude survival, progression free survival, and recurrence free survival (for patients with Ta and T1 tumors) were assessed in univariate and multivariate analysis according to stage, grade, mitotic index of the tumor, and patient age. The median value of continuous variables was used as a cutoff point in statistical analysis. RESULTS In univariate analysis there was a strong association between all included factors and crude survival, progression free survival, and recurrence free survival with a median follow-up period of 60 months. In multivariate analysis, crude survival and progression free survival were determined by stage (P = 0.0001) and age (P = 0.0001). Recurrence free survival for patients with Ta and T1 tumors was determined by MIB-1 labeling index (P = 0.0317), mitotic index (P = 0.0229), and age (P = 0.0001). CONCLUSIONS MIB-1 immunostaining in transitional cell carcinoma of the bladder correlated well with grade, stage, and clinical outcome. In multivariate analysis, proliferation fraction had prognostic value in predicting recurrence free survival for patients with Ta and T1 tumors, whereas stage and age appeared to be predictors of progression free survival.
Collapse
Affiliation(s)
- J W Oosterhuis
- Department of Surgery, Stichting Ziekenhuizen, Noord-Limburg, Venlo, The Netherlands
| | | | | | | | | |
Collapse
|
20
|
De Kok JB, Schalken JA, Aalders TW, Ruers TJ, Willems HL, Swinkels DW. Quantitative measurement of telomerase reverse transcriptase (hTERT) mRNA in urothelial cell carcinomas. Int J Cancer 2000. [DOI: 10.1002/1097-0215(20000715)87:2<217::aid-ijc10>3.0.co;2-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
21
|
Holmäng S, Hedelin H, Anderström C, Holmberg E, Busch C, Johansson SL. Recurrence and progression in low grade papillary urothelial tumors. J Urol 1999; 162:702-7. [PMID: 10458347 DOI: 10.1097/00005392-199909010-00019] [Citation(s) in RCA: 144] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We report long-term followup data on patients with World Health Organization (WHO) grade I bladder tumors, and determine whether histopathological subgrouping as papillary neoplasm of low malignant potential and low grade papillary carcinoma is of clinical value. MATERIALS AND METHODS All 680 patients in western Sweden with first diagnosis of bladder carcinoma in 1987 to 1988 were registered and followed for at least 5 years. Of the tumors 255 (37.5%) were stage Ta, WHO grade I. Tumors were further classified as papillary neoplasm of low malignant potential in 95 patients and low grade papillary carcinoma in 160 according to WHO and the International Society of Urological Pathology consensus classification of urothelial (transitional cell) neoplasms of the bladder. RESULTS Mean age of patients at first diagnosis of low grade papillary carcinoma was 69.2 years, which was 4.6 years higher than those with papillary neoplasm of low malignant potential (p<0.005). During a mean observation time of 60 months our 255 patients underwent 577 operations for recurrences and had 1,858 negative cystoscopies. The risk of recurrence was significantly lower in patients with papillary neoplasm of low malignant potential compared to those with low grade papillary carcinoma (35 versus 71%, p<0.001). The risk of recurrence was higher in patients with multiple tumors at first diagnosis as well as those with recurrence at the first followup after 3 to 4 months. Stage progressed in 6 patients (2.4%), all with low grade papillary carcinoma at diagnosis. CONCLUSIONS More than 90% of patients with stage Ta, WHO grade I have a benign form of bladder neoplasm, and few have truly malignant tumors. Future research should focus on reducing the number of recurrences and followup cystoscopies, and finding methods to identify malignant tumors so that pertinent treatment can be instituted. Subgrouping of WHO grade I bladder tumors as papillary neoplasm of low malignant potential and low grade papillary carcinoma seems to add valuable prognostic information.
Collapse
Affiliation(s)
- S Holmäng
- Department of Urology and Oncological Centre, Sahlgrenska University Hospital, Göteborg, Sweden
| | | | | | | | | | | |
Collapse
|
22
|
Harnden P, Parkinson M. Transitional cell carcinoma of the bladder: diagnosis and prognosis. ACTA ACUST UNITED AC 1996. [DOI: 10.1016/s0968-6053(96)80014-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|