ORIGINAL ARTICLE

Histological grading of papillary urothelial carcinoma of the bladder: prognostic value of the 1998 WHO/ISUP classification system and comparison with conventional grading systems

J W A Oosterhuis¹, R F M Schapers¹, M L G Janssen-Heijnen², R P E Pauwels³, D W Newling⁴ and F ten Kate⁵

¹ Department of Pathology, Stichting Ziekenhuizen Noord-Limburg, PO Box 1926, 5900 BX, Venlo, The Netherlands
² Comprehensive Cancer Centre South (IKZ), PO Box 231, 5600 AE, Eindhoven, The Netherlands
³ Department of Urology, Stichting Ziekenhuizen Noord-Limburg, PO Box 1926, 5900 BX, Venlo, The Netherlands
⁴ Department of Urology, VU Medisch Centrum, De Boelelaan 1117, 1081 MV, Amsterdam, The Netherlands
⁵ Department of Pathology, Academisch Medisch Centrum, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

Correspondence to:
Correspondence to:
Dr J W A Oosterhuis, Praubstraat 15, 8011 PN Zwolle, The Netherlands;
j.w.a.oosterhuis{at}isala.nl

Aim: To test the prognostic value of the 1998 WHO/ISUP (World Health Organisation/International Society of Urologic Pathology) consensus classification system in Ta papillary urothelial neoplasms of the bladder.

Methods: The histological slides of 322 patients with a primary Ta tumour were classified according to the consensus classification system, and recurrence free survival (RFS) and progression free survival (PFS) were assessed for a mean follow up period of 79 months. In the same patient group, the RFS and PFS rates for the 1973 WHO grading system and a low grade/high grade system were analysed.

Results: Recurrent tumours were seen in all categories of the 1998 WHO/ISUP classification system and five year RFS was not significantly different between the groups (p = 0.12). The five year PFS showed a small but significant difference (p = 0.04) between papillary neoplasms of low malignant potential (PNLMP) and high grade papillary urothelial carcinomas (HGPUCs). In the 1973 WHO classification, no significant difference was found in RFS and PFS between the different grades. In the low grade/high grade classification PFS was significantly better for low grade tumours (p = 0.01).

Conclusion: The prognostic value of the 1998 WHO/ISUP classification system is limited to predicting PFS, especially between PNLMP and HGPUC. The prognostic value of this system over other grading systems is questionable.

Keywords: bladder neoplasms; World Health Organisation/International Society of Urologic Pathology grading system; prognosis; progression; recurrence

Abbreviations: HGPUC, high grade papillary urothelial carcinoma; ISUP, International Society of Urologic Pathology; LGPUC, low grade papillary urothelial carcinoma; PFS, progression free survival; PNLMP, papillary neoplasm of low malignant potential; RFS, recurrence free survival; TUR, transurethral resection; WHO, World Health Organisation

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