The Importance of Being Grade 3 : A Plea for a Three-tier Hybrid Classification System for Grade in Primary Non–muscle-invasive Bladder Cancer
(2024) In European Urology 86(5). p.391-399- Abstract
Grade is an important determinant of progression in non–muscle-invasive bladder cancer. Although the World Health Organization (WHO) 2004/2016 grading system is recommended, other systems such as WHO1973 and WHO1999 are still widely used. Recently, a hybrid (three-tier) system was proposed, separating WHO2004/2016 high grade (HG) into HG/grade 2 (G2) and HG/G3 while maintaining low grade. We assessed the prognostic performance of HG/G3 and HG/G2. Three independent cohorts with 9712 primary (first diagnosis) Ta-T1 bladder tumors were analyzed. Time to progression was analyzed with cumulative incidence functions and Cox regression models. Harrell's C-index was used to assess discrimination. Time to progression was significantly shorter... (More)
Grade is an important determinant of progression in non–muscle-invasive bladder cancer. Although the World Health Organization (WHO) 2004/2016 grading system is recommended, other systems such as WHO1973 and WHO1999 are still widely used. Recently, a hybrid (three-tier) system was proposed, separating WHO2004/2016 high grade (HG) into HG/grade 2 (G2) and HG/G3 while maintaining low grade. We assessed the prognostic performance of HG/G3 and HG/G2. Three independent cohorts with 9712 primary (first diagnosis) Ta-T1 bladder tumors were analyzed. Time to progression was analyzed with cumulative incidence functions and Cox regression models. Harrell's C-index was used to assess discrimination. Time to progression was significantly shorter for HG/G3 than for HG/G2 in multivariable analyses (cohort 1: hazard ratio [HR] = 1.92; cohort 2: HR = 2.51, and cohort 3: HR = 1.69). Corresponding progression risks at 5 yr were 18%, 20%, and 18% for HG/G3 versus 7.3%, 7.5%, and 9.3% for HG/G2, respectively. Cox models using hybrid grade performed better than models with WHO2004/2016 (all cohorts; p < 0.001). For the three cohorts, C-indices for WHO2004/2016 were 0.69, 0.62, and 0.75, while, for hybrid grade, C-indices were 0.74, 0.68, and 0.78, respectively. Subdividing the HG category into HG/G2 and HG/G3 stratifies time to progression and supports the recommendation to adopt the hybrid grading system for Ta/T1 bladder cancers.
(Less)
- author
- author collaboration
- organization
- publishing date
- 2024-11
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Bladder, Cancer, Grading, Hybrid grade, World Health Organization 1973, World Health Organization 1999, World Health Organization 2004, World Health Organization 2016
- in
- European Urology
- volume
- 86
- issue
- 5
- pages
- 9 pages
- publisher
- Elsevier
- external identifiers
-
- pmid:39209674
- scopus:85202964808
- ISSN
- 0302-2838
- DOI
- 10.1016/j.eururo.2024.08.013
- language
- English
- LU publication?
- yes
- id
- 1a29171b-5ae3-4b10-89f1-2321359a993d
- date added to LUP
- 2024-12-16 10:24:07
- date last changed
- 2025-07-01 02:16:44
@article{1a29171b-5ae3-4b10-89f1-2321359a993d,
abstract = {{<p>Grade is an important determinant of progression in non–muscle-invasive bladder cancer. Although the World Health Organization (WHO) 2004/2016 grading system is recommended, other systems such as WHO1973 and WHO1999 are still widely used. Recently, a hybrid (three-tier) system was proposed, separating WHO2004/2016 high grade (HG) into HG/grade 2 (G2) and HG/G3 while maintaining low grade. We assessed the prognostic performance of HG/G3 and HG/G2. Three independent cohorts with 9712 primary (first diagnosis) Ta-T1 bladder tumors were analyzed. Time to progression was analyzed with cumulative incidence functions and Cox regression models. Harrell's C-index was used to assess discrimination. Time to progression was significantly shorter for HG/G3 than for HG/G2 in multivariable analyses (cohort 1: hazard ratio [HR] = 1.92; cohort 2: HR = 2.51, and cohort 3: HR = 1.69). Corresponding progression risks at 5 yr were 18%, 20%, and 18% for HG/G3 versus 7.3%, 7.5%, and 9.3% for HG/G2, respectively. Cox models using hybrid grade performed better than models with WHO2004/2016 (all cohorts; p < 0.001). For the three cohorts, C-indices for WHO2004/2016 were 0.69, 0.62, and 0.75, while, for hybrid grade, C-indices were 0.74, 0.68, and 0.78, respectively. Subdividing the HG category into HG/G2 and HG/G3 stratifies time to progression and supports the recommendation to adopt the hybrid grading system for Ta/T1 bladder cancers.</p>}},
author = {{Beijert, Irene J. and Hagberg, Oskar and Gårdmark, Truls and Holmberg, Lars and Häggström, Christel and Johnston, Allan and Trail, Matthew and Hamid, Sami and Dreyer, Barend A. and Padovani, Luisa and Garau, Roberta and Hasan, Rami and Ahmad, Imran and Hendry, David and Compérat, Eva M. and Burger, Maximilian and Rouprêt, Morgan and Gontero, Paolo and Ribal, Maria J. and van der Kwast, Theo H. and Babjuk, Marko and Sylvester, Richard J. and Mariappan, Paramananthan and Liedberg, Fredrik and van Rhijn, Bas W.G.}},
issn = {{0302-2838}},
keywords = {{Bladder; Cancer; Grading; Hybrid grade; World Health Organization 1973; World Health Organization 1999; World Health Organization 2004; World Health Organization 2016}},
language = {{eng}},
number = {{5}},
pages = {{391--399}},
publisher = {{Elsevier}},
series = {{European Urology}},
title = {{The Importance of Being Grade 3 : A Plea for a Three-tier Hybrid Classification System for Grade in Primary Non–muscle-invasive Bladder Cancer}},
url = {{http://dx.doi.org/10.1016/j.eururo.2024.08.013}},
doi = {{10.1016/j.eururo.2024.08.013}},
volume = {{86}},
year = {{2024}},
}