Prognostic Performance and Reproducibility of the 1973 and 2004/2016 World Health Organization Grading Classification Systems in Non-muscle-invasive Bladder Cancer: A European Association of Urology Non-muscle Invasive Bladder Cancer Guidelines Panel Systematic Review
Por:
Soukup, V, Capoun, O, Cohen, D, Hernandez, V, Babjuk, M, Burger, M, Comperat, E, Gontero, P, Lam, T, MacLennan, S, Mostafid, AH, Palou, J, van Rhijn, BWG, Roupret, M, Shariat, SF, Sylvester, R, Yuan, YH, Zigeuner, R
Publicada:
1 nov 2017
Resumen:
Context: Tumour grade is an important prognostic indicator in non-muscle-invasive bladder cancer (NMIBC). Histopathological classifications are limited by interobserver variability (reproducibility), which may have prognostic implications. European Association of Urology NMIBC guidelines suggest concurrent use of both 1973 and 2004/2016 World Health Organization (WHO) classifications.
Objective: To compare the prognostic performance and reproducibility of the 1973 and 2004/2016 WHO grading systems for NMIBC.
Evidence acquisition: A systematic literature search was undertaken incorporating Medline, Embase, and the Cochrane Library. Studies were critically appraised for risk of bias (QUIPS). For prognosis, the primary outcome was progression to muscle-invasive or metastatic disease. Secondary outcomes were disease recurrence, and overall and cancer-specific survival. For reproducibility, the primary outcome was interobserver variability between pathologists. Secondary outcome was intraobserver variability (repeatability) by the same pathologist.
Evidence synthesis: Of 3593 articles identified, 20 were included in the prognostic review; three were eligible for the reproducibility review. Increasing tumour grade in both classifications was associated with higher disease progression and recurrence rates. Progression rates in grade 1 patients were similar to those in low-grade patients; progression rates in grade 3 patients were higher than those in high-grade patients. Survival data were limited. Reproducibility of the 2004/2016 system was marginally better than that of the 1973 system. Two studies on repeatability showed conflicting results. Most studies had a moderate to high risk of bias.
Conclusions: Current grading classifications in NMIBC are suboptimal. The 1973 system identifies more aggressive tumours. Intra-and interobserver variability was slightly less in the 2004/2016 classification. We could not confirm that the 2004/2016 classification outperforms the 1973 classification in prediction of recurrence and progression.
Patient summary: This article summarises the utility of two different grading systems for non-muscle-invasive bladder cancer. Both systems predict progression and recurrence, although pathologists vary in their reporting; suggestions for further improvements are made. (C) 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Filiaciones:
Soukup, V:
Charles Univ Prague, Gen Teaching Hosp, Dept Urol, Prague, Czech Republic
Charles Univ Prague, Fac Med 1, Prague, Czech Republic
Capoun, O:
Charles Univ Prague, Gen Teaching Hosp, Dept Urol, Prague, Czech Republic
Charles Univ Prague, Fac Med 1, Prague, Czech Republic
Cohen, D:
Royal Free London NHS Fdn Trust, Dept Urol, London, England
Hernandez, V:
Hosp Univ Fdn Alcorcon, Dept Urol, Madrid, Spain
Babjuk, M:
Charles Univ Prague, Hosp Motol, Dept Urol, Prague, Czech Republic
Charles Univ Prague, Fac Med 2, Dept Urol, Prague, Czech Republic
Burger, M:
Univ Regensburg, Caritas St Josef Med Ctr, Dept Urol, Regensburg, Germany
Comperat, E:
Univ Paris 06, HUEP, Dept Pathol, Assistance Publ,Fac Med,Pierre & Marie Curie,Inst, Paris, France
Gontero, P:
Univ Turin, Dept Surg Sci, Urol, Turin, Italy
Lam, T:
Univ Aberdeen, Acad Urol Unit, Aberdeen, Scotland
Aberdeen Royal 12 Infirm, Dept Urol, Aberdeen, Scotland
MacLennan, S:
Univ Aberdeen, Acad Urol Unit, Aberdeen, Scotland
Mostafid, AH:
Royal Surrey Cty Hosp, Dept Urol, Guildford, Surrey, England
Palou, J:
Univ Autonoma Barcelona, Dept Urol, Fundacio Puigvert, Barcelona, Spain
van Rhijn, BWG:
Antoni van Leeuwenhoek Hosp, Netherlands Canc Inst, Dept Urol, Amsterdam, Netherlands
Roupret, M:
Univ Paris 06, Dept Urol, Grp Hosp Pitie Salpetriere, AP HP,Fac Med,Pierre & Marie Curie,Inst Univ Canc, Paris, France
Shariat, SF:
Med Univ Vienna, Vienna Gen Hosp, Dept Urol, Vienna, Austria
Sylvester, R:
European Assoc Urol, EAU Guidelines Off Board, Arnhem, Netherlands
Yuan, YH:
McMaster Univ, Dept Med, Hlth Sci Ctr, Hamilton, ON, Canada
Zigeuner, R:
Med Univ Graz, Dept Urol, Graz, Austria
Green Submitted
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