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Comparison between 1973 and 2004/2016 World Health Organization grading in upper tract urothelial carcinoma treated with radical nephroureterectomy

AIMS: The European Association of Urology guideline for upper tract urothelial carcinoma (UTUC) relies on two grading system: 1973 World Health Organization (WHO) and 2004/2016 WHO. No consensus has been made which classification should supersede the other and both are recommended in clinical practi...

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Autores principales: Collà Ruvolo , Claudia, Würnschimmel, Christoph, Wenzel, Mike, Nocera, Luigi, Celentano, Giuseppe, Mangiapia, Francesco, Tian, Zhe, Shariat, Shahrokh F., Saad, Fred, Chun, Felix H. C., Briganti, Alberto, Longo, Nicola, Mirone, Vincenzo, Karakiewicz, Pierre I.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Singapore 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8364897/
https://www.ncbi.nlm.nih.gov/pubmed/34091795
http://dx.doi.org/10.1007/s10147-021-01941-9
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author Collà Ruvolo , Claudia
Würnschimmel, Christoph
Wenzel, Mike
Nocera, Luigi
Celentano, Giuseppe
Mangiapia, Francesco
Tian, Zhe
Shariat, Shahrokh F.
Saad, Fred
Chun, Felix H. C.
Briganti, Alberto
Longo, Nicola
Mirone, Vincenzo
Karakiewicz, Pierre I.
author_facet Collà Ruvolo , Claudia
Würnschimmel, Christoph
Wenzel, Mike
Nocera, Luigi
Celentano, Giuseppe
Mangiapia, Francesco
Tian, Zhe
Shariat, Shahrokh F.
Saad, Fred
Chun, Felix H. C.
Briganti, Alberto
Longo, Nicola
Mirone, Vincenzo
Karakiewicz, Pierre I.
author_sort Collà Ruvolo , Claudia
collection PubMed
description AIMS: The European Association of Urology guideline for upper tract urothelial carcinoma (UTUC) relies on two grading system: 1973 World Health Organization (WHO) and 2004/2016 WHO. No consensus has been made which classification should supersede the other and both are recommended in clinical practice. We hypothesized that one may be superior to the other. METHODS: Newly diagnosed non-metastatic UTUC patients treated with radical nephroureterectomy were abstracted from the Surveillance, Epidemiology, and End Results database (2010–2016). Kaplan–Meier plots and multivariable Cox regression models (CRMs) tested cancer-specific mortality (CSM), according to 1973 WHO (G(1) vs. G(2) vs. G(3)) or to 2004/2016 WHO (low-grade vs. high-grade) grading systems. Haegerty’s C-index quantified accuracy. RESULTS: Of 4271 patients, according to 1973 WHO grading system, 134 (3.1%) were G(1), 436 (10.2%) were G(2) and 3701 (86.7%) were G(3); while according to 2004/2016 WHO grading system, 508 (11.9%) were low grade vs 3763 (88.1%) high grade. In multivariable CRMs, high grade predicted higher CSM (Hazard ratio: 1.70, p < 0.001). Conversely, neither G(2) (p = 0.8) nor G(3) (p = 0.1) were independent predictors of worse survival. The multivariable models without consideration of either grading system were 74% accurate in predicting 5-year CSM. Accuracy increased to 76% after either addition of the 1973 WHO or 2004/2016 WHO grade. CONCLUSIONS: From a statistical standpoint, either 1973 WHO or 2004/2016 WHO grading system improves the accuracy of CSM prediction to the same extent. In consequence, other considerations such as intra- and interobserver variability may represent additional metrics to consider in deciding which grading system is better. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10147-021-01941-9.
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spelling pubmed-83648972021-08-19 Comparison between 1973 and 2004/2016 World Health Organization grading in upper tract urothelial carcinoma treated with radical nephroureterectomy Collà Ruvolo , Claudia Würnschimmel, Christoph Wenzel, Mike Nocera, Luigi Celentano, Giuseppe Mangiapia, Francesco Tian, Zhe Shariat, Shahrokh F. Saad, Fred Chun, Felix H. C. Briganti, Alberto Longo, Nicola Mirone, Vincenzo Karakiewicz, Pierre I. Int J Clin Oncol Original Article AIMS: The European Association of Urology guideline for upper tract urothelial carcinoma (UTUC) relies on two grading system: 1973 World Health Organization (WHO) and 2004/2016 WHO. No consensus has been made which classification should supersede the other and both are recommended in clinical practice. We hypothesized that one may be superior to the other. METHODS: Newly diagnosed non-metastatic UTUC patients treated with radical nephroureterectomy were abstracted from the Surveillance, Epidemiology, and End Results database (2010–2016). Kaplan–Meier plots and multivariable Cox regression models (CRMs) tested cancer-specific mortality (CSM), according to 1973 WHO (G(1) vs. G(2) vs. G(3)) or to 2004/2016 WHO (low-grade vs. high-grade) grading systems. Haegerty’s C-index quantified accuracy. RESULTS: Of 4271 patients, according to 1973 WHO grading system, 134 (3.1%) were G(1), 436 (10.2%) were G(2) and 3701 (86.7%) were G(3); while according to 2004/2016 WHO grading system, 508 (11.9%) were low grade vs 3763 (88.1%) high grade. In multivariable CRMs, high grade predicted higher CSM (Hazard ratio: 1.70, p < 0.001). Conversely, neither G(2) (p = 0.8) nor G(3) (p = 0.1) were independent predictors of worse survival. The multivariable models without consideration of either grading system were 74% accurate in predicting 5-year CSM. Accuracy increased to 76% after either addition of the 1973 WHO or 2004/2016 WHO grade. CONCLUSIONS: From a statistical standpoint, either 1973 WHO or 2004/2016 WHO grading system improves the accuracy of CSM prediction to the same extent. In consequence, other considerations such as intra- and interobserver variability may represent additional metrics to consider in deciding which grading system is better. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10147-021-01941-9. Springer Singapore 2021-06-06 2021 /pmc/articles/PMC8364897/ /pubmed/34091795 http://dx.doi.org/10.1007/s10147-021-01941-9 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article
Collà Ruvolo , Claudia
Würnschimmel, Christoph
Wenzel, Mike
Nocera, Luigi
Celentano, Giuseppe
Mangiapia, Francesco
Tian, Zhe
Shariat, Shahrokh F.
Saad, Fred
Chun, Felix H. C.
Briganti, Alberto
Longo, Nicola
Mirone, Vincenzo
Karakiewicz, Pierre I.
Comparison between 1973 and 2004/2016 World Health Organization grading in upper tract urothelial carcinoma treated with radical nephroureterectomy
title Comparison between 1973 and 2004/2016 World Health Organization grading in upper tract urothelial carcinoma treated with radical nephroureterectomy
title_full Comparison between 1973 and 2004/2016 World Health Organization grading in upper tract urothelial carcinoma treated with radical nephroureterectomy
title_fullStr Comparison between 1973 and 2004/2016 World Health Organization grading in upper tract urothelial carcinoma treated with radical nephroureterectomy
title_full_unstemmed Comparison between 1973 and 2004/2016 World Health Organization grading in upper tract urothelial carcinoma treated with radical nephroureterectomy
title_short Comparison between 1973 and 2004/2016 World Health Organization grading in upper tract urothelial carcinoma treated with radical nephroureterectomy
title_sort comparison between 1973 and 2004/2016 world health organization grading in upper tract urothelial carcinoma treated with radical nephroureterectomy
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8364897/
https://www.ncbi.nlm.nih.gov/pubmed/34091795
http://dx.doi.org/10.1007/s10147-021-01941-9
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