Comparison of physical parameters and classification systems WHO 1973 and 2004/2016 in predicting the recurrence of NMIBC
Erdélyi Balázs dr.1, Mansour Bassel dr.1, Kovács István dr.1, Kovács Péter dr.1, Monyók Ádám dr.1, Vadnay István dr.2, Lovasné Avató Judit dr.3, Tóth Erika dr.4
1Markhot Ferenc Kórház, Urológiai Osztály, Eger (osztályvezető: Mansour Bassel dr.)
2Markhot Ferenc Kórház, Pathologiai Osztály, Eger (osztályvezető: Fullajtár Borbála dr.)
3Budapesti Gazdasági Egyetem, Üzleti Elemzés Módszertan Tanszék, Budapest (intézményvezető: Heidrich Balázs dr.)
4Országos Onkológiai Intézet, Molekuláris Patológiai Osztály, Budapest (osztályvezető: Tóth Erika dr.)
Introduction: Urothelial carcinoma is one of the most frequent urological neoplasms worldwide. Our objective was to analyse which physical tumour parameters and WHO grading systems are more reliable is predicting the recurrence of NMIBC.
Patients and methods: Our analysis took place in Markhot Ferenc Hospital, Eger, Heves County between 2009 and 2013 with 305 urothelial carcinoma diagnosed patients. The first histological results came from the local Department of Pathology with the grading system of WHO 1973. After that, the specimens were delivered to the National Institute of Oncology, Budapest, where they were re processed by the WHO 2004/2016 classification system.
Results: From the first pathological examination of all the 305 cases, 281 (92.13%) were proved to be malignant and 61.92% was NMIBC. 63.8% of the NMIBC’s were T1G1 and 24.72% were T1G2. In the re-procession in Budapest, 98.55% (273) of the appreciable (277) specimen proved to be urothelial carcinoma and 74.36% of these specimens were NMIBC. 84% of the specimes were the same stage in the re-procession, 13% proved to be lower, while 3% proved to be higher stage than the previous procession is Eger.
Compared those cases, when both procession proves to be NMIBC, our results were the following; from the T1G1 cases 63.64% was TaLG, 17.18% was TaHG, 19.2% wasT1HG. From the T1G2 specimens 15.79 was TaLG, 18.43% was TaHG and 65.79% was T1HG. In the WHO 1973 grading system, 75% of the Ta specimens was G1, 25% was G2. From the TaG1 specimens 16.67% was PUNLMP, 50% was TaLG and 33.34% was TaHG. 50-50% of the TaG2 blocks were TaLG and TaHG. In the re-evaluation, 66.43% of the original WHO 1973 T1 blocks (n=142) evaluated Ta, 32.87% remained T1, and 0.7% evaluated T2.
According to the WHO 1973 grading system all the NMIBC specimens (n=180), the recurrence rate was 20%. From these cases, 58.33% was T1G1, 30.55% was T1G2, 8.33% was TaG1 and 2.79% was TaG2. According to the WHO 2004/2016 system, the recurrence rate was 7.88% from the 204 NMIBC cases. 50% of the specimens are HG, 37.5% was TaHG and 2.5% was TaLG.
There was a significant correlation between the number of tumours (p=0.0064) tumour location (apex and right side p=0.0032) size (p=0.0517) and recurrence.
Our follow-up time of 7.66 years 78.3% of our patients were recurrence free.
Conclusion: In our analysis, the correlation between the physical parameters (numbers, size, localization) and recurrence rate of the tumour equals with high evidence studies. In terms of treatment and follow up of urothelial carcinoma, both of the grading systems are equally accepted. According to our analysis, the WHO 2004/2016 system predicts the recurrence rate more reliably. Despite our results, high quality evidence is available that applying of the two systems together has a benefit, and the experience of the pathologist in each grading system is the most important factor of reliability.