Comparison of 2004 and 1973 world health organization grading systems and their relationship to pathologic staging for predicting long-term prognosis in patients with urothelial carcinoma

Cao, Dengfeng, Vollmer, Robin T., Luly, Jason, Jain, Samay, Roytman, Timur M., Ferris, Charles W. and Hudson, M'Liss Ann (2010) Comparison of 2004 and 1973 world health organization grading systems and their relationship to pathologic staging for predicting long-term prognosis in patients with urothelial carcinoma. Urology, 76 3: 593-599. doi:10.1016/j.urology.2010.01.032


Author Cao, Dengfeng
Vollmer, Robin T.
Luly, Jason
Jain, Samay
Roytman, Timur M.
Ferris, Charles W.
Hudson, M'Liss Ann
Title Comparison of 2004 and 1973 world health organization grading systems and their relationship to pathologic staging for predicting long-term prognosis in patients with urothelial carcinoma
Journal name Urology   Check publisher's open access policy
ISSN 0090-4295
1527-9995
Publication date 2010
Year available 2010
Sub-type Article (original research)
DOI 10.1016/j.urology.2010.01.032
Open Access Status
Volume 76
Issue 3
Start page 593
End page 599
Total pages 7
Place of publication Bridgewater, NJ United States
Publisher Excerpta Medica, Inc.
Collection year 2010
Language eng
Subject 2748 Urology
Abstract Objectives: To compare the 1973 and 2004 World Health Organization (WHO) systems for the interval to tumor recurrence (TR), tumor progression (TP), and overall survival (OS) using either the superficial/muscle invasive or strict TMN pathologic staging in patients with urothelial carcinoma with <10 years of follow-up. Methods: A total of 269 tumors from an institutional review board-approved bladder tumor registry were graded using the 1973 and 2004 WHO systems. Kaplan-Meier plots, the log-rank test, the chi-square test, and the Cox proportional hazard model were used to relate the clinical and histologic variables. Results: The Cox model analyses, which were multivariate and included tumor stage (coded as pT1 or less versus pT2 or greater) as a significant covariate to grade, were performed and in all tumor stages were significant. The 2004 WHO grading system was more closely associated with TR (P = .025) and TP (P = .012) than was the 1973 WHO grading system (P = .47, and P = .046, respectively). OS was similar and significant for both. The OS plots for the 1973 WHO system showed a significant overlap between Stage pT1 or less, grade 2 and 3 tumors. For those with high-grade Stage pTa and high-grade Stage pT1 disease, TR and TP were similar; however, OS was significantly longer (P = .05, log-rank test) for those with Stage pTa. The OS was similar for those with high-grade Stage pT1 disease and those with Stage pT2 or greater (P = .069, log-rank test). For those with pTa, the 2004 system predicted TR and TP, but the 1973 system only predicted TP. Neither predicted OS. Conclusions: The results of our analysis have shown that the 2004 WHO system is superior to the 1973 system for predicting clinical outcomes in patients with urothelial carcinoma, independent of pathologic stage. Its primary usefulness is in those with Stage pTa.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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Created: Wed, 15 Jan 2014, 11:22:29 EST by Ms Kate Rowe on behalf of School of Medicine