PURPOSE: The pathological grade of bladder cancer has an immense impact on patient management and prognosis.
While most bladder tumors show pure high or low grade patterns, some tumors show a mixed pattern. We aimed to explore the incidence and the clinical significance of this phenomenon.
MATERIALS AND METHODS: Between June 1998 and December 2008, 642 patients (mean age of 67.5 years) underwent transurethral resection of non-muscle invasive bladder tumors, including 156, and 454 patients with low grade (LG) and high grade (HG), respectively. In 32 patients (5%), mixed grade (MG) tumors were found defined as LG tumors with ≤ 10% HG component. All patients were followed for a median period of 60 months post-operatively.
RESULTS: The mean age, the proportion of men and the proportions of stages Ta/T1 of patients with MG tumors were all in the middle between the HG and LG groups. The 5-year recurrence-free survival was similar for all tumor types (56.9%, 63.8%, 66.4% for HG, LG and MG respectively, p=0.252). The 5-year progression-free survival was significantly lower (p< 0.0001) in patients with HG (73.9%), but similar for patients with LG and MG tumors (99% and 96.9%, p=0.167). Similarly, disease specific survival was significantly worse for patients with HG tumor (p< 0.0001), but similar for patients with LG and MG (p=0.679).
CONCLUSIONS: MG tumors are found in about 5% of the non-muscle invasive tumors. They represent a group of patients with unique clinical features. The clinical course of patients with MG tumors parallels that of patients with LG tumors.
Written by:
Gofrit ON, Pizov G, Shapiro A, Duvdevani M, Yutkin V, Landau EH, Zorn KC, Hidas G, Pode D. Are you the author?
Department of Urology, Hadassah Hebrew University Hospital, Jerusalem.
Reference: J Urol. 2013 Dec 5. pii: S0022-5347(13)06014-X.
doi: 10.1016/j.juro.2013.11.056
PubMed Abstract
PMID: 24316096
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