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Reproducibility and Prognostic Value of WHO1973 and WHO2004 Grading Systems in TaT1 Urothelial Carcinoma of the Urinary Bladder

BACKGROUND: European treatment guidelines of TaT1 urinary bladder urothelial carcinomas depend highly on stage and WHO1973-grade but grading reproducibility is wanting. The newer WHO2004 grading system is still debated and both systems are currently used. AIMS: To compare reproducibility and prognos...

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Autores principales: Mangrud, Ok Målfrid, Waalen, Rune, Gudlaugsson, Einar, Dalen, Ingvild, Tasdemir, Ilker, Janssen, Emiel A. M., Baak, Jan P. A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3883638/
https://www.ncbi.nlm.nih.gov/pubmed/24409280
http://dx.doi.org/10.1371/journal.pone.0083192
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author Mangrud, Ok Målfrid
Waalen, Rune
Gudlaugsson, Einar
Dalen, Ingvild
Tasdemir, Ilker
Janssen, Emiel A. M.
Baak, Jan P. A.
author_facet Mangrud, Ok Målfrid
Waalen, Rune
Gudlaugsson, Einar
Dalen, Ingvild
Tasdemir, Ilker
Janssen, Emiel A. M.
Baak, Jan P. A.
author_sort Mangrud, Ok Målfrid
collection PubMed
description BACKGROUND: European treatment guidelines of TaT1 urinary bladder urothelial carcinomas depend highly on stage and WHO1973-grade but grading reproducibility is wanting. The newer WHO2004 grading system is still debated and both systems are currently used. AIMS: To compare reproducibility and prognostic value (of stage progression) of the WHO1973 and WHO2004. METHODS: One hundred and ninety-three primary urothelial carcinomas were reviewed. Follow-up data were retrieved from the patient records. Kappa statistics and Harrell's C-index were used. RESULTS: Median follow-up was 75 months (range 1–127). 17 patients (9%) progressed, 82% of these within and 18% after 60 months. The distribution of WHO73-grades 1, 2 and 3 was 23%, 51% and 26%, interobserver agreement for each individual grade was 66% (kappa = 0.68), while for grades 1&2 versus 3 89% (kappa = 0.68). Intraobserver reproducibility was 68–63% for WHO73 and 88–89% for WHO73 as 1&2 vs.3. Progression free survival rates at 5 years were 95% (grade 1), 98% (grade 2) and 82% (grade 3) and 96% and 82% for grades 1&2 versus 3 (Hazard Ratio, HR, 5.4, p = 0.003). Using WHO2004, 62% were low grade and 38% high grade, inter-observer agreement 87% (kappa = 0.70), intraobserver reproducibility 93%, and progression free 5-year survival rates 97% and 85% (HR 6.6, p = 0.004). Positive and negative predictive values for stage progression within 5 years for the WHO73 (1&2 vs. 3) were 18% and 96%, and 15% and 97% for the WHO04. Using Harrell's C-index, none of the grading systems was prognostically superior. CONCLUSION: None of the grading systems is prognostically stronger than the others. Most importantly, inter-observer reproducibility and sensitivities for stage progression of both systems are low and need improvement for optimal treatment.
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spelling pubmed-38836382014-01-09 Reproducibility and Prognostic Value of WHO1973 and WHO2004 Grading Systems in TaT1 Urothelial Carcinoma of the Urinary Bladder Mangrud, Ok Målfrid Waalen, Rune Gudlaugsson, Einar Dalen, Ingvild Tasdemir, Ilker Janssen, Emiel A. M. Baak, Jan P. A. PLoS One Research Article BACKGROUND: European treatment guidelines of TaT1 urinary bladder urothelial carcinomas depend highly on stage and WHO1973-grade but grading reproducibility is wanting. The newer WHO2004 grading system is still debated and both systems are currently used. AIMS: To compare reproducibility and prognostic value (of stage progression) of the WHO1973 and WHO2004. METHODS: One hundred and ninety-three primary urothelial carcinomas were reviewed. Follow-up data were retrieved from the patient records. Kappa statistics and Harrell's C-index were used. RESULTS: Median follow-up was 75 months (range 1–127). 17 patients (9%) progressed, 82% of these within and 18% after 60 months. The distribution of WHO73-grades 1, 2 and 3 was 23%, 51% and 26%, interobserver agreement for each individual grade was 66% (kappa = 0.68), while for grades 1&2 versus 3 89% (kappa = 0.68). Intraobserver reproducibility was 68–63% for WHO73 and 88–89% for WHO73 as 1&2 vs.3. Progression free survival rates at 5 years were 95% (grade 1), 98% (grade 2) and 82% (grade 3) and 96% and 82% for grades 1&2 versus 3 (Hazard Ratio, HR, 5.4, p = 0.003). Using WHO2004, 62% were low grade and 38% high grade, inter-observer agreement 87% (kappa = 0.70), intraobserver reproducibility 93%, and progression free 5-year survival rates 97% and 85% (HR 6.6, p = 0.004). Positive and negative predictive values for stage progression within 5 years for the WHO73 (1&2 vs. 3) were 18% and 96%, and 15% and 97% for the WHO04. Using Harrell's C-index, none of the grading systems was prognostically superior. CONCLUSION: None of the grading systems is prognostically stronger than the others. Most importantly, inter-observer reproducibility and sensitivities for stage progression of both systems are low and need improvement for optimal treatment. Public Library of Science 2014-01-07 /pmc/articles/PMC3883638/ /pubmed/24409280 http://dx.doi.org/10.1371/journal.pone.0083192 Text en © 2014 Mangrud et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Mangrud, Ok Målfrid
Waalen, Rune
Gudlaugsson, Einar
Dalen, Ingvild
Tasdemir, Ilker
Janssen, Emiel A. M.
Baak, Jan P. A.
Reproducibility and Prognostic Value of WHO1973 and WHO2004 Grading Systems in TaT1 Urothelial Carcinoma of the Urinary Bladder
title Reproducibility and Prognostic Value of WHO1973 and WHO2004 Grading Systems in TaT1 Urothelial Carcinoma of the Urinary Bladder
title_full Reproducibility and Prognostic Value of WHO1973 and WHO2004 Grading Systems in TaT1 Urothelial Carcinoma of the Urinary Bladder
title_fullStr Reproducibility and Prognostic Value of WHO1973 and WHO2004 Grading Systems in TaT1 Urothelial Carcinoma of the Urinary Bladder
title_full_unstemmed Reproducibility and Prognostic Value of WHO1973 and WHO2004 Grading Systems in TaT1 Urothelial Carcinoma of the Urinary Bladder
title_short Reproducibility and Prognostic Value of WHO1973 and WHO2004 Grading Systems in TaT1 Urothelial Carcinoma of the Urinary Bladder
title_sort reproducibility and prognostic value of who1973 and who2004 grading systems in tat1 urothelial carcinoma of the urinary bladder
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3883638/
https://www.ncbi.nlm.nih.gov/pubmed/24409280
http://dx.doi.org/10.1371/journal.pone.0083192
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