PD57-04 PROGNOSTIC VALUE OF THE WHO 1973 AND 2004 CLASSIFICATION SYSTEMS FOR GRADE IN NON-MUSCLE-INVASIVE T1 BLADDER CANCER

Abstract

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation III1 Apr 2017PD57-04 PROGNOSTIC VALUE OF THE WHO 1973 AND 2004 CLASSIFICATION SYSTEMS FOR GRADE IN NON-MUSCLE-INVASIVE T1 BLADDER CANCER Elisabeth Fransen van de Putte, Theodorus van der Kwast, Simone Bertz, Stefan Denzinger, Quentin Manach, Eva Compérat, Joost Boormans, Michael Jewett, Robert Stöhr, Alexandre Zlotta, Kees Hendricksen, Morgan Rouprêt, Wolfgang Otto, Maximilian Burger, Arndt Hartmann, and Bas van Rhijn Elisabeth Fransen van de PutteElisabeth Fransen van de Putte More articles by this author , Theodorus van der KwastTheodorus van der Kwast More articles by this author , Simone BertzSimone Bertz More articles by this author , Stefan DenzingerStefan Denzinger More articles by this author , Quentin ManachQuentin Manach More articles by this author , Eva CompératEva Compérat More articles by this author , Joost BoormansJoost Boormans More articles by this author , Michael JewettMichael Jewett More articles by this author , Robert StöhrRobert Stöhr More articles by this author , Alexandre ZlottaAlexandre Zlotta More articles by this author , Kees HendricksenKees Hendricksen More articles by this author , Morgan RouprêtMorgan Rouprêt More articles by this author , Wolfgang OttoWolfgang Otto More articles by this author , Maximilian BurgerMaximilian Burger More articles by this author , Arndt HartmannArndt Hartmann More articles by this author , and Bas van RhijnBas van Rhijn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2606AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Management of T1 bladder cancer (T1-BC) is a therapeutic challenge. Tumor grade is an important prognostic factor to aid in treatment decision making. Currently, the AUA guidelines advise use of WHO 2004 grade over the 1973 classification, although in the literature, neither has been proven superior over the other. In this study, we compared the prognostic value of these WHO classifications in T1-BC. METHODS Three uro-pathologists revised the slides of 601 primary (first diagnosis) T1-BCs from patients treated with BCG in four university hospitals between 1983 and 2006. Grade was defined according to WHO 1973 (grade 1-3) and 2004 (low-grade; LG and high-grade; HG). Association with progression-free survival (PFS) and cancer-specific survival (CSS) was analysed for each system with multivariable cox-regression models. We corrected for age, sex, multiplicity, size (>3cm vs. ≤3 cm) and concomitant CIS. RESULTS Median age was 71 (IQR 15) years and 196/601 (33%) tumors had concomitant CIS. After revision, 188 (31%) tumors were grade 2 and 413 (69%) grade 3 (WHO 1973). According to WHO 2004, 47 (8%) tumors were LG and 554 (92%) were HG. At a median follow-up of 5.9 (IQR 3.0) years, progression (≥cT2 and/or N1 and/or M1) occurred in 148 (25%) patients and 94 (16%) patients died of BC. Grade 3 tumors were associated with a worse PFS (HR 2.1, p<0.001) and CSS (HR 3.4, p<0.001) than grade 2 tumors. WHO 2004 grade had no prognostic value for progression (HG vs. LG HR 2.0, p=0.077) or CSS (HG vs. LG HR 1.6, p=0.292). The only prognostic factor for progression on multivariable analysis was WHO 1973 grade (HR 2.0, p=0.001). Grade 3 tumors (HR 3.0, p<0.001), increasing age (HR 1.03, p=0.003) and tumor size >3cm (HR 1.8, p=0.008) were all independently associated with worse CSS. CONCLUSIONS In T1-BC, WHO 1973 grade has a strong prognostic value, whereas the 2004 system is not prognostic. The superior value of WHO 1973 grade in T1-BC suggests that the 1973 system should be recommended by clinical non-muscle-invasive BC guidelines. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1122 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Elisabeth Fransen van de Putte More articles by this author Theodorus van der Kwast More articles by this author Simone Bertz More articles by this author Stefan Denzinger More articles by this author Quentin Manach More articles by this author Eva Compérat More articles by this author Joost Boormans More articles by this author Michael Jewett More articles by this author Robert Stöhr More articles by this author Alexandre Zlotta More articles by this author Kees Hendricksen More articles by this author Morgan Rouprêt More articles by this author Wolfgang Otto More articles by this author Maximilian Burger More articles by this author Arndt Hartmann More articles by this author Bas van Rhijn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...