title: Grading of superficial bladder cancer by quantitative mitotic frequency analysis.
abstract: A cohort of 270 superficial (stages Ta to T1) transitional cell bladder tumors was followed for more than 8 years. World Health Organization (WHO) grade, papillary status and 2 mitotic indexes were related to progression, recurrence-free survival and bladder cancer related survival during followup. Mitotic activity index and volume corrected mitotic index were significantly related to WHO grade and papillary status (p < 0.0001). WHO grade, papillary status and mitotic indexes were related significantly to progression in univariate analysis (p < 0.001) whereas in a multivariate analysis only volume corrected mitotic index included independent prognostic information (p < 0.001). Recurrence-free survival was related to volume corrected mitotic index in the entire cohort (p = 0.03) and in papillary tumors (p = 0.07). Bladder cancer related survival was related to WHO grade, papillary status, mitotic activity index and volume corrected mitotic index (all p < 0.0001). In papillary tumors mitotic activity index (p < 0.0001), volume corrected mitotic index (p < 0.0001) and WHO grade (p = 0.0036) predicted survival. In multivariate analysis mitotic activity index predicted independently recurrence-free survival in the entire cohort (p = 0.043) and in papillary tumors (p = 0.012). Bladder cancer survival in the entire cohort and in papillary tumors was related independently to volume corrected mitotic index (p < 0.001). The results show that superficial transitional cell bladder tumors can be efficiently categorized into prognostic groups by quantitative mitotic frequency analysis and the results provide a new classification system for superficial transitional cell bladder tumors.
authors.affiliation: Department of Pathology, University of Kuopio, Finland.
authors.forename: P K
authors.initials: PK
authors.lastname: Lipponen
authors.forename: M J
authors.initials: MJ
authors.lastname: Eskelinen
authors.forename: K
authors.initials: K
authors.lastname: Jauhiainen
authors.forename: E
authors.initials: E
authors.lastname: Harju
authors.forename: R
authors.initials: R
authors.lastname: Terho
authors.forename: H
authors.initials: H
authors.lastname: Haapasalo
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000235:genetics / Q000401:mortality / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008940:Mitotic Index; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000235:genetics / Q000401:mortality / Q000473:pathology*