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The importance of being grade 3: a plea for a three-tier hybrid classification system for grade in primary non–muscle-invasive bladder cancer
Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Urology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, Netherlands.
Institution of Translational Medicine, Lund University, Malmö, Sweden.
Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom.
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2024 (English)In: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 86, no 5, p. 391-399Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Elsevier, 2024. Vol. 86, no 5, p. 391-399
Keywords [en]
Bladder, Cancer, Grading, Hybrid grade, World Health Organization 1973, World Health Organization 1999, World Health Organization 2004, World Health Organization 2016
National Category
Clinical Medicine Cancer and Oncology
Identifiers
URN: urn:nbn:se:umu:diva-229416DOI: 10.1016/j.eururo.2024.08.013ISI: 001376630300001PubMedID: 39209674Scopus ID: 2-s2.0-85202964808OAI: oai:DiVA.org:umu-229416DiVA, id: diva2:1896275
Funder
Swedish Cancer Society, CAN 22 2021Swedish Cancer Society, CAN 2023/2807Swedish Research Council, 2021-00859Available from: 2024-09-10 Created: 2024-09-10 Last updated: 2025-02-18Bibliographically approved

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Häggström, Christel

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