BJU Int. 2015 Feb;115(2):267-73. doi: 10.1111/bju.12666.
To compare the clinical reliability of the 1973 and 2004 World Health Organisation (WHO) classification systems in pT1 bladder cancer.
We retrospectively evaluated 291 consecutive patients who had pT1 high grade bladder cancer between 2004 and 2011. All tumours were simultaneously evaluated by a single uro-pathologist as high grade and G2 or G3. All patients underwent a second transurethral resection (TUR) and those confirmed with non-muscle-invasive bladder cancer at second TUR received bacille Calmette-Guérin. Follow-up included urine cytology and cystoscopy 3 months after second TUR and then every 6 months for 5 years. Univariate and multivariate analysis to determine recurrence-free survival (RFS) and progression-free survival (PFS) rates were performed using the Kaplan–Meier method with the log-rank test.
G2 tumours were found in 124 (46.6%) and G3 in 142 (53.4%) patients. The mean (median; range) follow-up period was 31.1 (19; 1–93) months. The 5-year RFS rate was 39.1% for the overall high grade population, and 49.1 and 31.8% for G2 and G3 subgroups, respectively. The 5-year PFS was 82% for the overall high grade population and 89 and 73% for G2 and G3 subgroups, respectively. RFS (P < 0.002) and PFS (P < 0.001) rates were significantly different between the G2 and G3 subgroups. In multivariate analysis, only the grade assessed according to the 1973 WHO significantly correlated with both RFS (P = 0.003) and PFS (P < 0.001).
The results suggest that the 1973 WHO classification system has higher prognostic reliability for patients with T1 disease. If confirmed, these findings should be carefully taken into account when making treatment decisions for patients with T1 bladder cancer.
比较 1973 年和 2004 年世界卫生组织（WHO）分类系统在 pT1 膀胱癌中的临床可靠性。
我们回顾性评估了 2004 年至 2011 年间 291 例连续的 pT1 高级别膀胱癌患者。所有肿瘤均由同一位泌尿病理学家同时评估为高级别和 G2 或 G3。所有患者均行二次经尿道膀胱肿瘤切除术（TUR），第二次 TUR 证实为非肌层浸润性膀胱癌的患者接受卡介苗治疗。随访包括第二次 TUR 后 3 个月的尿液细胞学和膀胱镜检查，然后每 6 个月随访 5 年。采用 Kaplan-Meier 法和对数秩检验进行单变量和多变量分析，以确定无复发生存率（RFS）和无进展生存率（PFS）。
G2 肿瘤 124 例（46.6%），G3 肿瘤 142 例（53.4%）。平均（中位数；范围）随访时间为 31.1（19；1-93）个月。整体高级别人群的 5 年 RFS 率为 39.1%，G2 和 G3 亚组分别为 49.1%和 31.8%。整体高级别人群的 5 年 PFS 率为 82%，G2 和 G3 亚组分别为 89%和 73%。RFS（P<0.002）和 PFS（P<0.001）率在 G2 和 G3 亚组之间差异有统计学意义。多变量分析显示，只有根据 1973 年 WHO 分级评估的分级与 RFS（P=0.003）和 PFS（P<0.001）显著相关。
结果表明，1973 年 WHO 分类系统对 T1 疾病患者具有更高的预后可靠性。如果得到证实，这些发现应在为 T1 膀胱癌患者制定治疗决策时仔细考虑。
