The WHO classification of 1973 is more suitable than the WHO classification of 2004 for predicting survival in pT1 urothelial bladder cancer
The WHO classification of 1973 is more suitable than the WHO classification of 2004 for predicting survival in pT1 urothelial bladder cancer
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DOI：
10.1111/j.1464-410x.2010.09515.x
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发表时间：
2011-02-01
影响因子：
4.5
通讯作者：
Bertz, Simone
中科院分区：
文献类型：
--
作者：
Otto, Wolfgang;Denzinger, Stefan;Bertz, Simone
关于这件事我们知道些什么？我们首先比较了WHO 1973年和2004年对T1期膀胱癌分级的预后价值。目的确定世界卫生组织(WHO)1973年和2004年发表的PT1膀胱癌分级标准中哪一种更适合预测预后。Turb手术后立即行膀胱切除术或卡介苗(BCG)辅助治疗。采用Kaplan-Meier分析比较不同肿瘤分级(平均随访57个月)的生存率。结果根据1973年WHO分级标准，PT1BC中无一例为G1级，36%为G2级，%为G3级。根据2004年世界卫生组织的分类，组织学重新评估只突出了4%的低级别肿瘤和96%的高级别肿瘤。高级别肿瘤的10年特定癌症生存率(85%)介于G2(96%)和G3(78%)之间。结论本研究结果通过定义至少两个预后分组，支持1973年WHO分类更适合预测PT1肿瘤预后的假设。新的分类应该修改低级别和高级别PT1BC的定义，以保留肿瘤分级的预后价值。
What's known on the subject? and What does the study add?Grading so far is the most important prognostic parameter in non muscle-invasive urothelial bladder cancer.We first compared prognostic value of grading concerning WHO classifications 1973 and 2004 on stage T1 bladder cancer.OBJECTIVETo ascertain which of the currently defined World Health Organization (WHO) grading classifications of pT1 urothelial bladder cancer (BC), published in 1973 and 2004, is more suitable for predicting outcome.PATIENTS AND METHODSTransurethral resection of the bladder (TURB) specimens of 310 patients with first diagnosis of initial pT1 BC were reassessed by three urological pathologists according to the WHO classifications of 1973 and 2004. The TURB procedure was followed by either immediate cystectomy or adjuvant bacille Calmette-Guerin (BCG) instillations. Kaplan-Meier analysis was used to compare survival rates of the different tumour grades (mean follow-up was 57 months).RESULTSAccording to the 1973 WHO classification, none of the pT1 BC specimens were graded as G1, while 36% were graded as G2 and 64% were graded as G3. Histological reassessment according to the 2004 WHO classification highlighted only 4% low-grade and 96% high-grade tumours. The 10-year cancer-specific survival rates of high-grade tumours (85%) were intermediate between G2 (96%) and G3 (78%).CONCLUSIONSThe results of the present study support the presumption that the 1973 WHO classification is more suitable for predicting outcome for pT1 tumours, by defining at least two prognostic groups. A new classification should revise the definition of low- and high-grade pT1 BC to preserve the prognostic value of tumour grading.