The clinical significance of the new WHO/ISUP 2004 classification in pTa/pT1 bladder cancer carcinoma
Article published in Urologia Polska 2007/60/3.

authors

Anna Kołodziej, Romuald Zdrojowy, Sławomir Piotr Woźniak, Elżbieta Górzyńska2, Janusz Dembowski, Tomasz Szydełko, Tomasz Niezgoda, Paweł Kowal, Michał Wróbel, Bartosz Małkiewicz, Mariusz Kosiński, Jerzy Lorenz

Katedra i Klinika Urologii i Onkologii Urologicznej Akademii Medycznej we Wrocławiu
Pracownia Patomorfologii Wojewódzkiego Szpitala Specjalistycznego we Wrocławiu

keywords

urinary bladder, bladder cancer, WHO/ISUP classification

summary

Introduction. The 1973 World Health Organization (WHO) classification has been the most commonly used grading system for urothelial tumors. The main criticism against it has been the imprecise definition of individual grades. A new classification system, the WHO/International Society of Urological Pathologist (ISUP) Consensus Classification was published in 1998 and is equivalent to the WHO 2004 classification system. The aim of the study. To compare the usefulness of WHO/ISUP 2004 with the WHO 1973 classification in a large series of intermediate and high risk tumors treated with TURB and intravesical chemotherapy and BCG immunotherapy. We assessed the prognostic variability of grade and lamina propria invasion in stages Ta/T1 urothelial carcinoma of the bladder.

Material and methods. A total of 219 patients with pTa/T1 medium and high risk bladder tumors were identified. Patients were treated with TURB and intravesical chemotherapy and immunotherapy BCG (maintenance schedule). All tumors were revived by two independent experienced pathologist using 2004 WHO criteria. Recurrence and stage progression at follow-up was the dependent variable. The median follow-up was 62 months. Recurrence rate and stage progression-free Kaplan-Meier survival curves were calculated and prognostic variability was determined.

Results. The distribution of WHO papiloma, WHO G1, WHO G2 and WHO G3 was 0, 46, 42, and 10.9% respectively. The distribution jednoof WHO/ISUP 2004 papilloma, tumors of low malignant potential, low-grade carcinomas and high-grade carcinomas was 2, 3, 74, and 20%. The progression rate was 17.8%, 30% and 75% for G1, G2 and G3 tumors respectively. The corresponding progression rate WHO/ISUP 2004 was 0, 20.7, 5% and 68.1% for PUNLMP, PUCALG and PUCAHG respectively. In separate analyses grade of lamina propria invasion therapy were significant prognostic factors of recurrence and progression.

Conclusion. The WHO 1973 grade and WHO/ISUP 2004 grade and type of lamina propria invasion were significantly correlated with recurrence, progression and survival. WHO G3 has a slightly higher but without statistical significance progression rate compared with WHO/ISUP 2004 high-grade carcinoma. However, although only 10.9% of tumors were WHO G3; we were able to classify 20.1% as WHO/ISUP 2004 high-grade carcinoma with a poor prognosis. Its means, that we will be able to take to strict watchfull oncological observation a larger group of patients at high risk of progression.

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