Title: Survival following the diagnosis of noninvasive bladder cancer: WHO/International Society of Urological Pathology versus WHO classification systems.
Authors: Schned, Alan R; Andrew, Angeline S; Marsit, Carmen J; Zens, M Scot; Kelsey, Karl T; Karagas, Margaret R
Published In J Urol, (2007 Oct)
Abstract: The WHO/International Society of Urological Pathology classification of bladder cancer, introduced in 1998, differs from the traditional 1973 WHO classification. Few studies have reported survival data based on the WHO/International Society of Urological Pathology classification and none has demonstrated clear superiority compared to the 1973 WHO system. In a large, nonselected population of patients with bladder cancer we rated all incident tumors using each system and compared long-term patient survival.New Hampshire residents with bladder cancer diagnosed between 1994 and 2000 were identified through the State Cancer Registry. Slides were retrieved from more than 90% of cases and reviewed by a single pathologist. Tumors were classified according to WHO and WHO/International Society of Urological Pathology criteria. Overall patient survival was determined for the cohort of 504 patients after an average of 7 years using a national mortality database.For both grading systems there was a gradient of progressively lower survival times from the lowest grade to the highest grade tumors. Hazard ratios and 95% confidence intervals for the WHO/International Society of Urological Pathology system were 1.9 (1.0-3.4) for low grade papillary urothelial carcinoma and 3.0 (1.5-6.0) for high grade papillary urothelial carcinoma, compared to papillary urothelial neoplasms of low malignant potential. For the WHO (1973) system compared to grade 1 tumors the hazard ratio for grade 2 tumors was 1.8 (1.1-3.1) and for grade 3 was 2.4 (1.2-4.7).Advantages of the WHO/International Society of Urological Pathology bladder tumor classification include more detailed diagnostic criteria, the ability to define a lesion with minimal malignant potential and the ability to identify a larger group of patients needing closer surveillance. However, we found that the WHO/International Society of Urological Pathology tumor categories did not detect a clear overall survival advantage compared to the WHO (1973) classification system.
PubMed ID: 17698105
MeSH Terms: Aged; Carcinoma, Transitional Cell/diagnosis; Carcinoma, Transitional Cell/mortality; Carcinoma, Transitional Cell/pathology*; Cohort Studies; Female; Humans; Male; Middle Aged; Neoplasm Invasiveness/pathology; New Hampshire; Prognosis; Proportional Hazards Models; Registries; Survival Analysis; Urinary Bladder Neoplasms/diagnosis; Urinary Bladder Neoplasms/mortality; Urinary Bladder Neoplasms/pathology*; Urinary Bladder/pathology