Ano de Publicação: 2010
AUTORIA
Hiroshi Miyamoto, MD, PhD; Fadi Brimo, MD; Luciana Schultz, MD; Huihui Ye, MD; Jeremy S. Miller, MD; Daniel A. Fajardo,
MD, PhD; Thomas K. Lee, MD; Jonathan I. Epstein, MD; George J. Netto, MD
RESUMO
Context.—Few large cohort studies have addressed
outcome in patients with noninvasive low-grade papillary
urothelial carcinoma (LG-UrCa) following implementation
of the 2004 World Health Organization/International
Society of Urological Pathology (WHO/ISUP) consensus
classification.
Objective.—To evaluate our cohort of LG-UrCa cases
classified according to 2004 WHO/ISUP to reassess
outcome and interobserver agreement.
Design.—Files were searched for all patients diagnosed
with LG-UrCa between 1998 and 2008. All sections were
reevaluated for accuracy of classification.
Results.—A total of 112 cases initially diagnosed as
LG-UrCa were identified. Of those, 8 of 55 cases
(15%) initially diagnosed by nonurologic pathologists
were reclassified as high-grade papillary urothelial
carcinoma and were excluded. The mean length of
follow-up was 40.1 months (range, 2–113 months).
Tumor recurrence was encountered in 56 of 104
patients (53.8%), including 37 (35.6%) with LG-UrCa
or lower-grade tumors and 19 (18.3%) with highgrade
papillary urothelial carcinoma. Of the 19 patients
demonstrating grade progression, 7 (37%) also developed
stage progression (invasive carcinoma, n = 5;
metastatic carcinoma, n = 2). Seven patients eventually
underwent radical cystectomy. None of the 104 patients
died of bladder cancer. The mean number of recurrence
episodes was 3.11. The mean durations of time to first
recurrence and time to grade progression were 13.9
months and 25.1 months, respectively. The mean size of
initial tumors was 1.73 cm. There was no significant
correlation between tumor size, patient age, sex, or
smoking history and the likelihood for recurrence or grade
progression. A significantly higher rate of recurrence was
seen in patients with multiple tumors at initial diagnosis (P
= .04).
Conclusions.—A tendency to underdiagnose high-grade
papillary urothelial carcinoma continues to exist. More
than half (53.8%) of patients with LG-UrCa developed
recurrence, with an 18.3% incidence of grade progression
and a 6.7% incidence of stage progression. Patients with
multiple initial tumors had significantly higher risk of
developing recurrence.
(Arch Pathol Lab Med. 2010;134:1160–1163)