Prognostic Factors of ‘High-Grade' Ta Bladder Cancers according to the WHO 2004 Classification: Are These Equivalent to ‘High-Risk' Non-Muscle-Invasive Bladder Cancer?
| Autor: | Chiara Fiorito, Giovanni Casetta, Andrea Zitella, Arianna Gillo, Paolo Gontero, Donatella Pacchioni, Fulvio Ricceri, Francesca Peraldo, Alessandro Tizzani, Marco Oderda |
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| Rok vydání: | 2013 |
| Předmět: |
Male
Risk Oncology medicine.medical_specialty Multivariate analysis Urology Urinary Bladder Kaplan-Meier Estimate Disease World Health Organization Severity of Illness Index Disease-Free Survival Cohort Studies Internal medicine Severity of illness medicine Humans Neoplasm Invasiveness Grading (education) Aged Proportional Hazards Models Gynecology Neoplasm Grading Bladder cancer Proportional hazards model business.industry Middle Aged Prognosis medicine.disease Immunohistochemistry Treatment Outcome Urinary Bladder Neoplasms Multivariate Analysis Disease Progression Female Neoplasm Recurrence Local business Follow-Up Studies Cohort study |
| Zdroj: | Urologia Internationalis. 92:136-142 |
| ISSN: | 1423-0399 0042-1138 |
| DOI: | 10.1159/000351961 |
| Popis: | Objective: To determine the impact of prognostic factors of a series of high-grade Ta non-muscle-invasive bladder cancers (NMIBCs) according to the new International Society of Urological Pathology (ISUP) 1998/WHO 2004 grading system (previously classified as either TaG2 or TaG3). Methods: One hundred and thirty-one high-grade Ta (105 G2 and 26 G3) cases were identified after independent review by two pathologists. Univariable and multivariable Cox regression models addressed recurrence and progression-free survival. Progression was defined as appearance of any T ≥1 recurrence after complete TUR (type 1) or occurrence of T ≥2 (type 2). Results: Ten-year recurrence, type-1 and type-2 progression-free survival were 60, 75 and 95%, respectively. The previous grading system (G3 vs. G2) significantly predicted type 1 progression in the univariate model only. In the multivariate model, Ki67 was the only independent predictor of progression according to both definitions (HR = 5.25, p = 0.002 and HR = 6.16, p = 0.03, respectively). Conclusions: High-grade Ta NMIBC as defined by the WHO 2004 grading system cannot be equated with high-risk NMIBC. The risk of progression to muscle-invasive disease (type 2) is low, more in keeping with an intermediate-risk category of NMIBC. The previous WHO 1973 subcategorization into G2 and G3 is of little help in the prediction of outcome. Ki67 is a strong independent predictor of progression worthy of consideration for a clinical setting. |
| Databáze: | OpenAIRE |
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