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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
BWG. van Rhijn, AE. Hentschel, J. Bründl, EM. Compérat, V. Hernández, O. Čapoun, HM. Bruins, D. Cohen, M. Rouprêt, SF. Shariat, AH. Mostafid, R. Zigeuner, JL. Dominguez-Escrig, M. Burger, V. Soukup, P. Gontero, J. Palou, TH. van der Kwast, M....
Jazyk angličtina Země Nizozemsko
Typ dokumentu časopisecké články, multicentrická studie
- MeSH
- cystektomie MeSH
- lidé MeSH
- nádory močového měchýře * chirurgie terapie MeSH
- prognóza MeSH
- senioři MeSH
- stupeň nádoru MeSH
- urologie * MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
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.
Pathology Tenon Hospital AP HP Sorbonne University Paris France
Urology Amsterdam University Medical Centers Vrije Universiteit Amsterdam The Netherlands
Urology Caritas St Josef Medical Center University of Regensburg Regensburg Germany
Urology Città della Salute e della Scienza University of Torino School of Medicine Torino Italy
Urology Comprehensive Cancer Center Medical University Vienna Vienna General Hospital Vienna Austria
Urology Fundacio Puigvert Universitat Autònoma de Barcelona Barcelona Spain
Urology Fundación Instituto Valenciano de Oncología Valencia Spain
Urology Hospital Universitario Fundación Alcorcón Madrid Spain
Urology Medical University of Graz Graz Austria
Urology Pitié Salpétrière Hospital AP HP GRC n°5 ONCOTYPE URO Sorbonne University Paris France
Urology Radboud University Medical Center Nijmegen The Netherlands
Urology Royal Free London NHS Foundation Trust Royal Free Hospital London UK
Urology The Stokes Centre for Urology Royal Surrey Hospital Guildford UK
Citace poskytuje Crossref.org
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- $a van Rhijn, Bas W G $u 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. Electronic address: basvanrhijn@hotmail.com
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