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World Journal of Urology

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01-12-2015 | Original Article

Impact of 2004 ISUP/WHO classification on bladder cancer grading

Authors: Soum D. Lokeshwar, Roberto Ruiz-Cordero, Marie C. Hupe, Merce Jorda, Mark S. Soloway

Published in: World Journal of Urology | Issue 12/2015

Abstract

Purpose

To determine whether implementation of the 2004 WHO/ISUP bladder cancer (BCa) grading system caused a grade migration, i.e., more tumors being graded as high grade (HG).

Methods

Data on 1040 BCa cases from 668 patients treated at our institution between 2000 and 2013 and reviewed by six pathologists were evaluated: low grade (LG): 249; HG: 791; Ta: 389; T1: 214; CIS: 95; ≥T2: 342. Differences in LG or HG cases (expressed as %BCa cases/year) were analyzed by Mann–Whitney test. Correlation between the year of diagnosis and clinical/pathological parameters was evaluated by logistic regression analyses.

Results

During the study period, BCa cases diagnosed as LG significantly decreased with a corresponding increase in HG cases. Nonlinear regression analysis indicated that ~2008 was the crossover point for grade migration; %LG: 31.8 ± 4.8 (2000–2007); 14.1 ± 7.0 (2008–2013); %HG: 68.2 ± 4.8 (2000–2007); 85.9 ± 6.9 (2008–2013), P = 0.004. The grade migration was confined to Ta cases with %LG Ta cases diagnosed decreasing by 3.6-fold from 2000–2007 to 2008–2013 (P = 0.004). Univariate and multivariate analyses confirmed the grade migration following the adoption of the 2004 system (P < 0.0001). Kaplan–Meier curves showed no significant differences between the two time intervals in terms of disease progression (P > 0.05).

Conclusions

Implementation of the 2004 WHO/ISUP system caused a significant increase in pathologists grading Ta cases as HG; however, this increase did not seem to correlate with disease progression. Since LG and HG Ta tumors are treated differently, grade migration may impact the clinical management of BCa patients.

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Title: Impact of 2004 ISUP/WHO classification on bladder cancer grading
Authors: Soum D. Lokeshwar
Roberto Ruiz-Cordero
Marie C. Hupe
Merce Jorda
Mark S. Soloway
Publication date: 01-12-2015
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 12/2015
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-015-1548-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Impact of 2004 ISUP/WHO classification on bladder cancer grading

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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