Rinderknecht, Emily and Claps, Francesco and Bostrom, Peter J. and Shariat, Shahrokh F. and Neuzillet, Yann and Zlotta, Alexandre R. and Trombetta, Carlo and Eckstein, Markus and Lijnen, Renee A. G. and Mertens, Laura S. and Bussani, Rossana and Burger, Maximilian and Van Leenders, Geert J. L. H. and Boormans, Joost L. and Wullich, Bernd and Hartmann, Arndt and Pavan, Nicola and Pouessel, Damien and Van Der Kwast, Theo H. and Allory, Yves and Zuiverloon, Tahlita C. M. and Lotan, Yair and van Rhijn, Bas W. G. and Mayr, Roman (2025) Is histological grade a useful parameter in muscle-invasive urothelial bladder cancer? Results from a multicenter study on the impact of different grading systems on disease-free survival after upfront radical cystectomy. WORLD JOURNAL OF UROLOGY, 43 (1): 705. ISSN 0724-4983, 1433-8726
Full text not available from this repository. (Request a copy)Abstract
Purpose The prognostic value of histopathological grade in muscle-invasive urothelial carcinoma (MIBC) to predict disease-specific survival (DSS) is understudied. While grading systems like WHO1973 and WHO2004 are established in non-muscle-invasive bladder cancer (NMIBC), their relevance in MIBC remains controversial. This study assessed the prognostic impact of histopathological grade on DSS in a multicenter cohort. Methods We included 1,123 cN0M0 MIBC patients treated with upfront radical cystectomy (1987-2020) at nine centers. Tumors were graded using WHO1973 (G1 + G2 combined as G1/2 due to low numbers vs. G3), WHO2004 (low-grade [LG] vs. high-grade [HG]), and a hybrid three-tier system. Slides were locally reviewed by uro-pathologists. DSS was analyzed using Kaplan-Meier and Cox models, adjusting for age, stage, lympho-vascular invasion, surgical margins, lymph-node status, adjuvant chemotherapy, treatment center, and era of cystectomy. Results Among all cases, 74 (6.6%) were G1/2 and 1,049 (93.4%) G3; 27 (2.4%) were LG and 1,096 (97.6%) HG. Median follow-up was 5.3 years (IQR 2.9-8.5). Univariable analyses showed significantly better DSS for LG and G1/2 tumors across grading systems. However, multivariable models showed no independent association between grade and DSS. Conclusion Although LG and G1/2 MIBC tumors demonstrated superior DSS in univariable analyses, the lack of independent prognostic significance in multivariable models questions the relevance of histopathological grade in MIBC. Further studies should explore the clinical utility of grade, define new grading schemes including features of epithelial-mesenchymal transition or tumor microenvironment, and explore alternative prognostic (bio)markers.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | CARCINOMA; Urothelial neoplasm; Urothelial carcinoma; Histopathological grade; WHO1973 classification; WHO2004 classification; Radical cystectomy |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Urologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 20 Apr 2026 06:32 |
| Last Modified: | 20 Apr 2026 06:32 |
| URI: | https://pred.uni-regensburg.de/id/eprint/67635 |
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