Papillary urothelial neoplasm of low malignant potential (PUN-LMP): Still a meaningful histo-pathological grade category for Ta, noninvasive bladder tumors in 2019?
Jazyk angličtina Země Spojené státy americké Médium print-electronic
Typ dokumentu časopisecké články, multicentrická studie
PubMed
31704141
DOI
10.1016/j.urolonc.2019.10.002
PII: S1078-1439(19)30401-6
Knihovny.cz E-zdroje
- Klíčová slova
- Bladder, Cancer, Carcinomas, Grade, Nonmuscle-invasive, Urothelial, WHO,
- MeSH
- invazivní růst nádoru MeSH
- karcinom z přechodných buněk patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lokální recidiva nádoru epidemiologie MeSH
- nádory močového měchýře patologie MeSH
- odchylka pozorovatele MeSH
- papilární karcinom patologie MeSH
- retrospektivní studie MeSH
- senioři MeSH
- stupeň nádoru MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Geografické názvy
- Evropa MeSH
- Kanada MeSH
BACKGROUND: Papillary urothelial neoplasm of low malignant potential (PUN-LMP) was introduced as a noninvasive, noncancerous lesion and a separate grade category in 1998. Subsequently, PUN-LMP was reconfirmed by World Health Organization (WHO) 2004 and WHO 2016 classifications for urothelial bladder tumors. OBJECTIVES: To analyze the proportion of PUN-LMP diagnosis over time and to determine its prognostic value compared to Ta-LG (low-grade) and Ta-HG (high-grade) carcinomas. To assess the intraobserver variability of an experienced uropathologist assigning (WHO) 2004/2016 grades at 2 time points. MATERIALS AND METHODS: Individual patient data of 3,311 primary Ta bladder tumors from 17 hospitals in Europe and Canada were available. Transurethral resection of the tumor was performed between 1990 and 2018. Time to recurrence and progression were analyzed with cumulative incidence functions, log-rank tests and multivariable Cox-regression stratified by institution. Intraobserver variability was assessed by examining the same 314 transurethral resection of the tumorslides twice, in 2004 and again in 2018. RESULTS: PUN-LMP represented 3.8% (127/3,311) of Ta tumors. The same pathologist found 71/314 (22.6%) PUN-LMPs in 2004 and only 20/314 (6.4%) in 2018. Overall, the proportion of PUN-LMP diagnosis substantially decreased over time from 31.3% (1990-2000) to 3.2% (2000-2010) and to 1.1% (2010-2018). We found no difference in time to recurrence between the three WHO 2004/2016 Ta-grade categories (log-rank, P = 0.381), nor for LG vs. PUN-LMP (log-rank, P = 0.238). Time to progression was different for all grade categories (log-rank, P < 0.001), but not between LG and PUN-LMP (log-rank, P = 0.096). Multivariable analyses on recurrence and progression showed similar results for all 3 grade categories and for LG vs. PUN-LMP. CONCLUSIONS: The proportion of PUN-LMP has decreased to very low levels in the last decade. Contrary to its reconfirmation in the WHO 2016 classification, our results do not support the continued use of PUN-LMP as a separate grade category in Ta tumors because of the similar prognosis for PUN-LMP and Ta-LG carcinomas.
EAU Guidelines Office Board European Association of Urology Arnhem the Netherlands
Health Evidence Radboud University Medical Center Nijmegen the Netherlands
Pathology Caritas St Josef Medical Center University of Regensburg Regensburg Germany
Pathology Citta' della Salute e della Scienza University of Studies of Torino Torino Italy
Pathology Fundacio Puigvert Universitat Autònoma de Barcelona Barcelona Spain
Pathology Fundación Instituto Valenciano de Oncología Valencia Spain
Pathology Hospital Universitario Fundación Alcorcón Madrid Spain
Pathology Medical University of Graz Graz Austria
Pathology Radboud University Medical Center Nijmegen the Netherlands
Pathology Royal Free London NHS Foundation Trust Royal Free Hospital London United Kingdom
Pathology Teaching Hospital Motol Prague Czech Republic
Pathology Tenon Hospital AP HP UPMC Paris 6 Sorbonne University Paris France
Urology Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam the Netherlands
Urology Caritas St Josef Medical Center University of Regensburg Regensburg Germany
Urology Clinic Citta' della Salute e della Scienza University of Studies of Torino 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 United Kingdom
Urology Royal Surrey County Hospital NHS Foundation Trust Guildford Surrey United Kingdom
Urology Teaching Hospital Motol Prague Czech Republic
Urology Tenon Hospital AP HP UPMC Paris 6 Sorbonne University Paris France
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