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Level of mitoses in non-muscle invasive papillary urothelial carcinomas (pTa and pT1) at initial bladder biopsy is a simple and powerful predictor of clinical outcome: A multi-center study in South Korea

Title
Level of mitoses in non-muscle invasive papillary urothelial carcinomas (pTa and pT1) at initial bladder biopsy is a simple and powerful predictor of clinical outcome: A multi-center study in South Korea
Authors
Kwon J.E.Cho N.H.Choi Y.-J.Lim S.D.Cho Y.M.Jun S.Y.Park S.Kim Y.A.Kim S.-S.Choe M.S.Lee J.-D.Kang D.Y.Ro J.Y.Kim H.-J.
Ewha Authors
박상희
SCOPUS Author ID
박상희scopus
Issue Date
2017
Journal Title
Diagnostic Pathology
ISSN
1746-1596JCR Link
Citation
vol. 12, no. 1
Keywords
Clinical outcomeMitotic levelPapillary urothelial carcinomaPredictor
Publisher
BioMed Central Ltd.
Indexed
SCIE; SCOPUS WOS scopus
Abstract
Background: Histologic grade is the most important predictor of the clinical outcome of non-muscle invasive (Ta, T1) papillary urothelial carcinoma (NMIPUCa), but its ambiguous criteria diminish its power to predict recurrence/progression for individual patients. We attempted to find an objective and reproducible histologic predictor of NMIPUCa that correlates well with the clinical outcome. Methods: A total of 296 PUCas were collected from the Departments of Surgical Pathology of 11 institutions in South Korea. The clinical outcome was grouped into no event (NE), recurrence (R), and progression (P) categories. All 25 histological parameters were numerically redefined. The clinical pathology of each case was reviewed individually by 11 pathologists from 11 institutions based on the 2004 WHO criteria and afterwards blindly evaluated by two participants, based on our proposed parameters. Univariate and multivariate logistic regression analyses were performed using the R software package. Results: The level of mitoses was the most reliable parameter for predicting the clinical outcome. We propose a four-tiered grading system based on mitotic count (> 10/10 high-power fields), nuclear pleomorphism (smallest-to-largest ratio of tumor nuclei >20), presence of divergent histology, and capillary proliferation (> 20 capillary lumina per papillary core). Conclusions: The level of mitoses at the initial bladder biopsy and transurethral resection (TUR) specimen appeared to be an independent predictor of the Ta PUCa outcome. Other parameters include the number of mitoses, nuclear pleomorphism, divergent histology, and capillary proliferation within the fibrovascular core. These findings may improve selection of patients for a therapeutic strategy as compared to previous grading systems. © 2017 The Author(s).
DOI
10.1186/s13000-017-0639-y
Appears in Collections:
의학전문대학원 > 의학과 > Journal papers
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