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

URN zum Zitieren dieses Dokuments:

urn:nbn:de:bvb:355-epub-781954 Copy

DOI zum Zitieren dieses Dokuments:

10.5283/epub.78195 Copy

Rinderknecht, Emily ; Claps, Francesco ; Bostrom, Peter J. ; Shariat, Shahrokh F. ; Neuzillet, Yann ; Zlotta, Alexandre R. ; Trombetta, Carlo ; Eckstein, Markus ; Lijnen, Renee A. G. ; Mertens, Laura S. ; Bussani, Rossana ; Burger, Maximilian ; van Leenders, Geert J. L. H. ; Boormans, Joost L. ; Wullich, Bernd ; Hartmann, Arndt ; Pavan, Nicola ; Pouessel, Damien ; van der Kwast, Theo H. ; Allory, Yves ; Zuiverloon, Tahlita C. M. ; Lotan, Yair ; van Rhijn, Bas W. G. ; Mayr, Roman

Lizenz: Creative Commons Namensnennung 4.0 International PDF - Veröffentlichte Version (974kB)

Veröffentlichungsdatum dieses Volltextes: 25 Nov 2025 05:13

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Diese Publikation ist Teil des DEAL-Vertrags mit Springer.

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Details

Dokumentenart:	Artikel
Open Access Art:	DEAL (Springer)
Titel eines Journals oder einer Zeitschrift:	World Journal of Urology
Verlag:	Springer
Band:	43
Nummer des Zeitschriftenheftes oder des Kapitels:	1
Datum:	20 November 2025
Institutionen:	Medizin > Lehrstuhl für Urologie
Identifikationsnummer:	Wert Typ 10.1007/s00345-025-06089-z DOI
Stichwörter / Keywords:	Urothelial neoplasm · Urothelial carcinoma · Histopathological grade · WHO1973 classification · WHO2004 classification · Radical cystectomy
Dewey-Dezimal-Klassifikation:	600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin
Status:	Veröffentlicht
Begutachtet:	Ja, diese Version wurde begutachtet
An der Universität Regensburg entstanden:	Zum Teil
Dokumenten-ID:	78195

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Zusammenfassung

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 ...

Zusammenfassung

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.

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