Grading of human urothelial carcinoma based on nuclear atypia and mitotic frequency. II. Prognostic importance.
A grading system was applied in a retrospective study of 124 patients with transitional cell carcinoma of the bladder using a modified Bergkvist system. The intermediate World Health Organization (WHO) grade II tumors were divided into supposedly benign and malignant forms of grades IIa and IIb, respectively. The 5-year survival was 92% for patients with grade IIa urothelial carcinoma, compared to 43% for patients with grade IIb tumors. The corresponding figures for grades I and III tumors were 100 and 44%, respectively. When excluding carcinoma in situ (5-year survival 50%) no patient with a noninvasive tumor (stage Ta) died of bladder carcinoma within 5 years, compared to 50% of those with invasive cancers (stages T1 to T4). We propose a new grading system in which grades I and IIa are embraced as grade A, grades IIb and III as grade B, and grade IV as grade C. The 5-year survival rate in the 3 grades was 94, 44 and 27%, respectively. Grade A seems to represent a type of tumor with universally favorable prognosis, in contrast to grades B and C. This offers practical advantages, since the former can be treated conservatively, whereas the latter need more urgent radical intervention, especially in patients in whom invasive growth is recorded.
Carbin
B E
BE
Department of Urology, Karolinska Hospital, Stockholm, Sweden.
Ekman
P
P
Gustafson
H
H
Christensen
N J
NJ
Silfverswärd
C
C
Sandstedt
B
B
D002295:Carcinoma, Transitional Cell / Q000145:classification / Q000401:mortality* / Q000473:pathology; D002467:Cell Nucleus / Q000648:ultrastructure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008940:Mitotic Index; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D001743:Urinary Bladder / Q000473:pathology*; D001749:Urinary Bladder Neoplasms / Q000145:classification / Q000401:mortality* / Q000473:pathology; D014944:World Health Organization