Impact of 2004 ISUP/WHO classification on bladder cancer grading
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 path...
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| Veröffentlicht in: | World journal of urology 2015-12, Vol.33 (12), p.1929-1936 |
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| creator | Lokeshwar, Soum D. Ruiz-Cordero, Roberto Hupe, Marie C. Jorda, Merce Soloway, Mark S. |
| description | 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
0.05).
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. |
| doi_str_mv | 10.1007/s00345-015-1548-x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1735910366</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3873019401</sourcerecordid><originalsourceid>FETCH-LOGICAL-c442t-b245b4b8f14c7f2d15a877a7cb644909986c4769766c66ada5c72be2fb60bf13</originalsourceid><addsrcrecordid>eNp1kF1LwzAUhoMobk5_gDdS8MabupM0H-2dMtQNBhOceBmSNB0dXTuTFua_N7NTRBAC5yLPec85D0KXGG4xgBh7gISyGDCLMaNpvDtCQ0yTJE4F4cdoCILQmGZpMkBn3q8BsODATtGAsDRJOMdDdDfbbJVpo6aICACNZi-vz-O36SIylfK-LEqj2rKpo_B0pfLcusio2oSyciov69U5OilU5e3FoY7Q8vFhOZnG88XTbHI_jw2lpI01oUxTnRaYGlGQHDOVCqGE0ZzSDLIs5YYKngnODecqV8wIoi0pNAdd4GSEbvrYrWveO-tbuSm9sVWlatt0XmKRsAxDOCqg13_QddO5Oiz3ReFUACGBwj1lXOO9s4XcunKj3IfEIPd2ZW9XBrtyb1fuQs_VIbnTG5v_dHzrDADpAR--6pV1v0b_m_oJlrWCDQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1735187022</pqid></control><display><type>article</type><title>Impact of 2004 ISUP/WHO classification on bladder cancer grading</title><source>MEDLINE</source><source>Springer Online Journals Complete</source><creator>Lokeshwar, Soum D. ; Ruiz-Cordero, Roberto ; Hupe, Marie C. ; Jorda, Merce ; Soloway, Mark S.</creator><creatorcontrib>Lokeshwar, Soum D. ; Ruiz-Cordero, Roberto ; Hupe, Marie C. ; Jorda, Merce ; Soloway, Mark S.</creatorcontrib><description>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.</description><identifier>ISSN: 0724-4983</identifier><identifier>EISSN: 1433-8726</identifier><identifier>DOI: 10.1007/s00345-015-1548-x</identifier><identifier>PMID: 25833661</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Aged ; Aged, 80 and over ; Bladder cancer ; Female ; Humans ; Kaplan-Meier Estimate ; Logistic Models ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Neoplasm Grading ; Neoplasm Staging ; Nephrology ; Oncology ; Original Article ; Pathology, Clinical ; Prognosis ; Reproducibility of Results ; Retrospective Studies ; Societies, Medical ; Urinary Bladder Neoplasms - classification ; Urinary Bladder Neoplasms - pathology ; Urology</subject><ispartof>World journal of urology, 2015-12, Vol.33 (12), p.1929-1936</ispartof><rights>Springer-Verlag Berlin Heidelberg 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c442t-b245b4b8f14c7f2d15a877a7cb644909986c4769766c66ada5c72be2fb60bf13</citedby><cites>FETCH-LOGICAL-c442t-b245b4b8f14c7f2d15a877a7cb644909986c4769766c66ada5c72be2fb60bf13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00345-015-1548-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00345-015-1548-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25833661$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lokeshwar, Soum D.</creatorcontrib><creatorcontrib>Ruiz-Cordero, Roberto</creatorcontrib><creatorcontrib>Hupe, Marie C.</creatorcontrib><creatorcontrib>Jorda, Merce</creatorcontrib><creatorcontrib>Soloway, Mark S.</creatorcontrib><title>Impact of 2004 ISUP/WHO classification on bladder cancer grading</title><title>World journal of urology</title><addtitle>World J Urol</addtitle><addtitle>World J Urol</addtitle><description>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.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Bladder cancer</subject><subject>Female</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neoplasm Grading</subject><subject>Neoplasm Staging</subject><subject>Nephrology</subject><subject>Oncology</subject><subject>Original Article</subject><subject>Pathology, Clinical</subject><subject>Prognosis</subject><subject>Reproducibility of Results</subject><subject>Retrospective Studies</subject><subject>Societies, Medical</subject><subject>Urinary Bladder Neoplasms - classification</subject><subject>Urinary Bladder Neoplasms - pathology</subject><subject>Urology</subject><issn>0724-4983</issn><issn>1433-8726</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kF1LwzAUhoMobk5_gDdS8MabupM0H-2dMtQNBhOceBmSNB0dXTuTFua_N7NTRBAC5yLPec85D0KXGG4xgBh7gISyGDCLMaNpvDtCQ0yTJE4F4cdoCILQmGZpMkBn3q8BsODATtGAsDRJOMdDdDfbbJVpo6aICACNZi-vz-O36SIylfK-LEqj2rKpo_B0pfLcusio2oSyciov69U5OilU5e3FoY7Q8vFhOZnG88XTbHI_jw2lpI01oUxTnRaYGlGQHDOVCqGE0ZzSDLIs5YYKngnODecqV8wIoi0pNAdd4GSEbvrYrWveO-tbuSm9sVWlatt0XmKRsAxDOCqg13_QddO5Oiz3ReFUACGBwj1lXOO9s4XcunKj3IfEIPd2ZW9XBrtyb1fuQs_VIbnTG5v_dHzrDADpAR--6pV1v0b_m_oJlrWCDQ</recordid><startdate>20151201</startdate><enddate>20151201</enddate><creator>Lokeshwar, Soum D.</creator><creator>Ruiz-Cordero, Roberto</creator><creator>Hupe, Marie C.</creator><creator>Jorda, Merce</creator><creator>Soloway, Mark S.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20151201</creationdate><title>Impact of 2004 ISUP/WHO classification on bladder cancer grading</title><author>Lokeshwar, Soum D. ; Ruiz-Cordero, Roberto ; Hupe, Marie C. ; Jorda, Merce ; Soloway, Mark S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c442t-b245b4b8f14c7f2d15a877a7cb644909986c4769766c66ada5c72be2fb60bf13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Bladder cancer</topic><topic>Female</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Neoplasm Grading</topic><topic>Neoplasm Staging</topic><topic>Nephrology</topic><topic>Oncology</topic><topic>Original Article</topic><topic>Pathology, Clinical</topic><topic>Prognosis</topic><topic>Reproducibility of Results</topic><topic>Retrospective Studies</topic><topic>Societies, Medical</topic><topic>Urinary Bladder Neoplasms - classification</topic><topic>Urinary Bladder Neoplasms - pathology</topic><topic>Urology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lokeshwar, Soum D.</creatorcontrib><creatorcontrib>Ruiz-Cordero, Roberto</creatorcontrib><creatorcontrib>Hupe, Marie C.</creatorcontrib><creatorcontrib>Jorda, Merce</creatorcontrib><creatorcontrib>Soloway, Mark S.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>World journal of urology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lokeshwar, Soum D.</au><au>Ruiz-Cordero, Roberto</au><au>Hupe, Marie C.</au><au>Jorda, Merce</au><au>Soloway, Mark S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of 2004 ISUP/WHO classification on bladder cancer grading</atitle><jtitle>World journal of urology</jtitle><stitle>World J Urol</stitle><addtitle>World J Urol</addtitle><date>2015-12-01</date><risdate>2015</risdate><volume>33</volume><issue>12</issue><spage>1929</spage><epage>1936</epage><pages>1929-1936</pages><issn>0724-4983</issn><eissn>1433-8726</eissn><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.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>25833661</pmid><doi>10.1007/s00345-015-1548-x</doi><tpages>8</tpages></addata></record> |
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| subjects | Aged Aged, 80 and over Bladder cancer Female Humans Kaplan-Meier Estimate Logistic Models Male Medicine Medicine & Public Health Middle Aged Neoplasm Grading Neoplasm Staging Nephrology Oncology Original Article Pathology, Clinical Prognosis Reproducibility of Results Retrospective Studies Societies, Medical Urinary Bladder Neoplasms - classification Urinary Bladder Neoplasms - pathology Urology |
| title | Impact of 2004 ISUP/WHO classification on bladder cancer grading |
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