CODE: 8.2 - The relevance of WHO/ISUP 2004 classification of high risk Ta/T1 urothelial bladder tumors
Article published in Urologia Polska 2006/59/Suplement 1.

authors

Anna Kołodziej, Romuald Zdrojowy, Janusz Dembowski, Tomasz Szydełko, Tadeusz Niezgoda, Jarosław Kasprzak, Paweł Kowal, Jerzy Lorenz

Katedra i Klinika Urologii i Onkologii Urologicznej we Wrocławiu

summary

Introduction. A number of classification systems have been used to grade papillary urothelial neoplasm of the bladder, with the WHO classification, introduced in 1973, one of the most widely used. A lack of precise definitions for the various histologic descriptions have resulted in difficulty in applying some of these systems, with demonstrated marked interobserver and intraobserver variability. The disparity among systems has also resulted in confusion with regard to prognostication and treatment. In an attempt to develop a universally acceptable classification system for bladder neoplasia the WHO/Internal Society of Urological Pathology (ISUP) consensus classification for grading of these tumors was introduced in 2004.

Objectives. Comparison of WHO/ISUP 2004 and WHO 1973 classification of Ta/T1 papillary urothelial neoplasm for risk of progression.

Materials and methods. A total of 219 patients with Ta/T1 high risk bladder cancer treated with TURB in our departments in 1995-2005 years were analysed. In 190 (87%) patients intravesical, "single shot" chemotherapy was done directly after TURB, additionally 128 (58.4%) patients were treated with immunotherapy - BCG (maintenance scheme 6+3). Histopathological specimens were re-reviewed and assigned a WHO/ISUP grade and lamina propria invasion.The WHO grade used was that assigned on the original pathology report, so as not to introduce a grading bias. The correlation between clinical course of the disease-recurrence, progression and histopathological prognostic markers were analysed.

Results. The distribution of WHO 1973 papilloma, G1, G2, G3 was 0, 46.2%, 42.8%, 11%, respectively. The distribution of WHO/ISUP papilloma, PUNLMP, PUCALG, PUCAHG was 1.8%, 3.2%, 74.8%, 20.1%, respectively. In the mean time of 58 months, progression was noticed in 17.8% G1 tumors, 30% G2, 75% G3 and 11.5% PUCALG and 68.1% PUCAHG tumors. In separate statistical analyses WHO grade, WHO/ISUP grade, massive lamina propria invasion and intravesical BCG therapy were independent predictors of recurrence and progression.

Conclusions. 1. The new classification WHO/ISUP was able to separate a twice larger (PUCAHG 20.1% versus G3 10.9%) group of patients with a poor prognosis what allows urologists for more close oncological follow up for this patients. 2. Patients with pT1 tumors and massive invasion of lamina propria mucosae have much higher risk of progression and death of disease in comparison with patients with pTa tumors.