Prognostic value of the 1973 and 2004/2016 WHO grading systems in primary Ta/T1 non-muscle invasive urothelial carcinoma of the bladder: A multicenter EAU NMIBC guidelines panel study

Burger, Max M.; Comperat, E.; Babjuk, M.; Sylvester, R.

doi:10.1016/s1569-9056(19)30462-2

Cited by 2 publications

(5 citation statements)

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“…12 Similarly, a retrospective multicentre study of 5145 primary Ta/T1 papillary NMIBC among 17 institutions showed that neither WHO 2004 nor 1973 grading predicted recurrence, but both systems were prognostic for progression to muscle-invasive (T2) carcinoma with a 5-year progression risk of 13.7 and 18.8% for WHO 2004 HG and WHO 1973 G3 bladder cancer, respectively (Figure 1). 20 Two recent separate studies (one Canadian, one Swedish) confirmed the importance of distinguishing G2-HG from G3-HG, as both found a statistically significant difference in progression risk between these two groups. 13,18 Both studies convincingly demonstrated superiority of the hybrid WHO 1973/2004 grading system over two-tier WHO 2004 using area under the curve or Harrell's concordance index statistics using stage progression as outcome parameter.…”

Section: Categories (Lg Hg): Dr Comp Eratmentioning

confidence: 87%

“…With reference to clinical prognostic significance, one study comparing the WHO 1973 and 2004 grading systems showed a significant stepwise increase in biological (molecular markers) and clinical (stage progression) potential from G1/LG to G2/LG, G2/HG and G3/HG (Figure 1). 19,20 A systematic review revealed that in Ta/T1 bladder cancers the WHO 1973 G3 cancers were at higher risk of stage progression than WHO 2004 HG cancers. 12 Similarly, a retrospective multicentre study of 5145 primary Ta/T1 papillary NMIBC among 17 institutions showed that neither WHO 2004 nor 1973 grading predicted recurrence, but both systems were prognostic for progression to muscle-invasive (T2) carcinoma with a 5-year progression risk of 13.7 and 18.8% for WHO 2004 HG and WHO 1973 G3 bladder cancer, respectively (Figure 1).…”

Section: Categories (Lg Hg): Dr Comp Eratmentioning

confidence: 99%

“…10 For T1 bladder cancer, several studies showed a minimal impact of WHO 2004 grading, as T1 LG bladder cancers are exceedingly rare, whereas the WHO 1973 grading system was a consistent prognostic parameter for stage progression. 20,21 The hybrid three-tier grading system retains this advantage of Figure 1. Five-year stage progression rates by grade for each of the four grading systems.…”

Section: Categories (Lg Hg): Dr Comp Eratmentioning

confidence: 99%

“…The percentages at the bottom represent the proportion of patients with this specific grade. Data adapted from van Rhijn et al 20 the WHO 1973 grading. 22 In the case of urothelial subtype morphology, the proposed hybrid three-tier grading system would only be applicable for the conventional urothelial carcinoma component in addition to the reporting of the subtype (e.g.…”

Section: Categories (Lg Hg): Dr Comp Eratmentioning

confidence: 99%

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Head‐to‐head: how many categories for grading urothelial carcinoma?

Varma,

Compérat,

van der Kwast

2023

Histopathology

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Tumour grade is a critical prognostic parameter for guiding the management of patients with non‐muscle invasive bladder cancer. In 2004, the World Health Organisation (WHO) adopted a binary (low‐grade/high‐grade) grading system to replace the three‐tier (grades 1–3) system used to grade urothelial carcinoma since 1973. However, there is significant global variation in the grading of urothelial carcinoma. Some pathology and clinical guidelines recommend reporting of the WHO 1973 and 2004 grades in parallel, while others require reporting only of the WHO 2004 grade. This variation in pathology practice is clinically significant, because the two grading systems are not readily translatable. Some experts have proposed novel systems for grading urothelial carcinoma that involve splitting of the WHO 1973 and 2004 grade categories. The arguments for and against splitting urothelial carcinomas into two‐, three‐ and four‐grade categories are independently discussed by the three authors.

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Section: Categories (Lg Hg): Dr Comp Eratmentioning

confidence: 87%

Section: Categories (Lg Hg): Dr Comp Eratmentioning

confidence: 99%

Section: Categories (Lg Hg): Dr Comp Eratmentioning

confidence: 99%

Section: Categories (Lg Hg): Dr Comp Eratmentioning

confidence: 99%

See 2 more Smart Citations

Head‐to‐head: how many categories for grading urothelial carcinoma?

Varma,

Compérat,

van der Kwast

2023

Histopathology

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“…The updated EAU guidelines recommend the use of both the WHO 1973 and 2004/2016 grading classifications, while our data are based upon only the 2004/2016 grading system. This is more applicable to the real-world situation since, although the 1973 system may have improved prognostic importance, 11 the 2004/2016 system is more widely utilized.…”

Section: Discussionmentioning

confidence: 99%

All High-Grade Ta Tumors Should Be Classified as High Risk: Bacillus Calmette-Guérin Response in High-Grade Ta Tumors

et al. 2022

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Purpose: There is variation amongst guidelines with respect to risk stratification of Ta tumors, specifically high-grade (HG) Ta tumors. We sought to investigate the response of all Ta tumors to bacillus Calmette-Gu erin (BCG) and compare response rates based on European Association of Urology (EAU) classification as intermediate-(IR) or high-risk (HR). Materials and Methods: An institutional review of all patients who received adequate BCG from 2000e2018 was conducted. EAU 2021 prognostic risk groups were used to stratify patients including by the newly proposed adverse risk factors. Results: When patient with Ta tumors were stratified into IR and HR, 37 (16%) had IR low-grade (LG) Ta, 92 (40%) had IR HG Ta and 101 (44%) had HR HG Ta tumors. BCG unresponsiveness developed in 13% of HR HG Ta tumors and 14% of IR HG Ta tumors compared to 0.0% of IR LG Ta tumors (p[0.003). While no patients with IR LG Ta tumors progressed, progression rates were similar in HR HG Ta and IR HG Ta tumors (T2: 5.9% and 6.5%; T1: 13% and 13%, respectively). Rates of recurrence, BCG unresponsiveness and progression were similar, irrespective of number of EAU risk factors present (p[0.9, p[0.8 and p[0.9, respectively). Conclusions: All HG Ta tumors, regardless of EAU risk stratification, have inferior response to BCG and increased rates of progression compared to IR LG Ta tumors. EAU clinical risk factors did not improve prediction of oncologic outcomes among HG Ta patients who received adequate BCG. These data support consideration of all HG tumors as high risk.

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Prognostic value of the 1973 and 2004/2016 WHO grading systems in primary Ta/T1 non-muscle invasive urothelial carcinoma of the bladder: A multicenter EAU NMIBC guidelines panel study

Cited by 2 publications

References 0 publications

Head‐to‐head: how many categories for grading urothelial carcinoma?

Head‐to‐head: how many categories for grading urothelial carcinoma?

All High-Grade Ta Tumors Should Be Classified as High Risk: Bacillus Calmette-Guérin Response in High-Grade Ta Tumors

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