Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press43010.17650/1726-9776-2016-12-1-21-28DIAGNOSIS AND TREATMENT OF URINARY SYSTEM TUMORS. URINARY BLADDER CANCERДИАГНОСТИКА И ЛЕЧЕНИЕ ОПУХОЛЕЙ МОЧЕПОЛОВОЙ СИСТЕМЫ. Рак мочевого пузыряInterobserver reproducibility of pathological variables in patients with high grade non-muscle invasive bladder cancerМежисследовательская воспроизводимость определения морфологических параметров при раке мочевого пузыря без мышечной инвазии с неблагоприятным прогнозомNabebinaT. I.НабебинаТ. И.
Belarus

Lesnoy Settlement, Minsk District 223040

223 040, Минский район, пос. Лесной

nabebina.t@yandex.byRolevichA. I.РолевичА. И.
Belarus

Lesnoy Settlement, Minsk District 223040

223 040, Минский район, пос. Лесной

DubrovskyA. Ch.ДубровскийА. Ч.
Belarus

Lesnoy Settlement, Minsk District 223040

223 040, Минский район, пос. Лесной

KrasnyS. A.КрасныйС. А.
Belarus

Lesnoy Settlement, Minsk District 223040

223 040, Минский район, пос. Лесной

N.N. Aleksandrov Republican Research and Practical Center for Oncology and Medical RadiologyРеспубликанский научно-практический центр онкологии и медицинской радиологии им. Н. Н. Александрова3003201612121281205201505112015https://oncourology.abvpress.ru/oncur/article/view/430

The purpose of our study was to assess the interobserver variability in tumor stage and grade in patients with non-muscle invasive transitional cell bladder cancer. The prognostic relevance of grade and stage from both the initial and review diagnosis were determined. Pathological slides from 154 superficial bladder carcinomas were reviewed. Progression-free survival and hazard ratios for each stage and grade were calculated with Kaplan-Meyer method and Cox proportional model. There were significant interobserver differences in both the grading and staging of tumours. In pathology review overgrading was more frequent than undergrading, pathology review downstaged T category to stage Ta in 60,0 % of cases originally classified as stage T1.

Цель исследования – оценка межисследовательской изменчивости определения степени злокачественности и категории рТ при переходно-клеточном раке (ПКР) мочевого пузыря без мышечной инвазии, а также прогностического значения морфологических параметров, полученных при повторном пересмотре. В ходе исследования осуществлена повторная световая микроскопия гистологических микропрепаратов 154 пациентов. Проведена статистическая обработка результатов, полученных при первичном и повторном пересмотрах. Установлено наличие высокой вариабельности гистологических заключений и низкой степени межисследовательского согласия при определении морфологических характеристик опухоли: при повторном пересмотре микропрепаратов имелась тенденция к установлению более высокой степени злокачественности ПКР, категория рТ1 подтверждена у 40% пациентов, у 60 % категория рT1 понизилась до рТа.

bladder cancertumor gradepT categoryinterobserver variabilityprognostic valueрак мочевого пузырястепень злокачественностикатегория рТмежисследовательская изменчивостьпрогностическое значение1.Океанов А.Е., Моисеев П.И., Левин Л.Ф. Статистика онкологических заболеваний в Республике Беларусь (2004–2013). Под ред. О.Г. Суконко. Минск: РНПЦ ОМР им. Н.Н. Александрова, 2014. С. 171–177. [Оkeanov А.Е., Моiseev P.I., Levin L.F. Statistics of oncologic diseases in the Republic of Belarus (2004–2013). Ed. by О.G. Sukonkо. Мinsk: N.N. Alexandrov RSPC ОМR, 2014. P. 171–177 (In Russ.)].Океанов А.Е., Моисеев П.И., Левин Л.Ф. Статистика онкологических заболеваний в Республике Беларусь (2004–2013). Под ред. О.Г. Суконко. Минск: РНПЦ ОМР им. Н.Н. Александрова, 2014. С. 171–177. [Оkeanov А.Е., Моiseev P.I., Levin L.F. Statistics of oncologic diseases in the Republic of Belarus (2004–2013). Ed. by О.G. Sukonkо. Мinsk: N.N. Alexandrov RSPC ОМR, 2014. P. 171–177 (In Russ.)].2. Sievert K.D., Amend B., Nagele U. et al. Economic aspects of bladder cancer: what are the benefits and costs? World J Urol 2009;27:295–300.Sievert K.D., Amend B., Nagele U. et al. Economic aspects of bladder cancer: what are the benefits and costs? World J Urol 2009;27:295–300.3. van Rhijn B.W.G., Burger M., Lotan Y. et al. Recurrence and progression of disease in non-muscle-invasive bladder cancer: from epidemiology to treatment strategy. Eur Urol 2009;56:430–42.van Rhijn B.W.G., Burger M., Lotan Y. et al. Recurrence and progression of disease in non-muscle-invasive bladder cancer: from epidemiology to treatment strategy. Eur Urol 2009;56:430–42.4. Sylvester R.J., van der Meijden A.P.M., Oosterlinck W. et al. Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol 2006;49:466–77.Sylvester R.J., van der Meijden A.P.M., Oosterlinck W. et al. Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol 2006;49:466–77.5. Fernandez-Gomez J., Solsona E., Unda M. et al. Prognostic factors in patients with non–muscle-invasive bladder cancer treated with bacillus Calmette-Gue′rin: multivariate analysis of data from four randomized CUETO trials. Eur Urol 2008;53:992–1002.Fernandez-Gomez J., Solsona E., Unda M. et al. Prognostic factors in patients with non–muscle-invasive bladder cancer treated with bacillus Calmette-Gue′rin: multivariate analysis of data from four randomized CUETO trials. Eur Urol 2008;53:992–1002.6. Mostofi F.K., Sobin L.H, Torloni H. Histological typing of urinary bladder tumours. Geneva, Switzerland: World Health Organization, 1973.Mostofi F.K., Sobin L.H, Torloni H. Histological typing of urinary bladder tumours. Geneva, Switzerland: World Health Organization, 1973.7. Eble J., Sauter G., Epstein J. et al. Pathology and genetics of tumours of the urinary system and male genital organs. Lyon, France: IARC Press, 2004.Eble J., Sauter G., Epstein J. et al. Pathology and genetics of tumours of the urinary system and male genital organs. Lyon, France: IARC Press, 2004.8. Shim J.-W., Cho K.S., Choi Y-D. et al. Diagnostic algorithm for papillary urothelial tumors in the urinary bladder. Virchows Arch 2008;452:353–62.Shim J.-W., Cho K.S., Choi Y-D. et al. Diagnostic algorithm for papillary urothelial tumors in the urinary bladder. Virchows Arch 2008;452:353–62.9. Bostwick D.G., Mikuz G. Urothelial papillary (exophytic) neoplasms. Virchows Arch 2002;44:109–16.Bostwick D.G., Mikuz G. Urothelial papillary (exophytic) neoplasms. Virchows Arch 2002;44:109–16.10. Van Rhijn B.W.G., van der Kwast T.H., Alkhateeb S.S. et al. A new and highly prognostic system to discern T1 bladder cancer substage. Eur Urol 2012;61:378–84.Van Rhijn B.W.G., van der Kwast T.H., Alkhateeb S.S. et al. A new and highly prognostic system to discern T1 bladder cancer substage. Eur Urol 2012;61:378–84.11. Witjes J.A., Kiemeney L.A.L.M., Schaafsmas H.E. et al. The influence of review pathology on study outcome of a randomized multicentre superficial bladder cancer trial. BJU 1994;73:172–6.Witjes J.A., Kiemeney L.A.L.M., Schaafsmas H.E. et al. The influence of review pathology on study outcome of a randomized multicentre superficial bladder cancer trial. BJU 1994;73:172–6.12. Van der Meijden A., Sylvester R., Collette L. et al. The role and impact of pathology review on stage and grade assessment of stages Тa and Т1 bladder tumors: a combined analysis of 5 european organization for research and treatment of cancer trials. J Urol 2000;164:1533–7.Van der Meijden A., Sylvester R., Collette L. et al. The role and impact of pathology review on stage and grade assessment of stages Тa and Т1 bladder tumors: a combined analysis of 5 european organization for research and treatment of cancer trials. J Urol 2000;164:1533–7.13. Bol M.G.W., Baak J.P.A., Buhr-Wildhagen S. et al. Reproducibility and prognostic variability of grade and lamina propria invasion in stages Ta, T1 urothelial carcinoma of the bladder. J Urology 2003;169:1291–4.Bol M.G.W., Baak J.P.A., Buhr-Wildhagen S. et al. Reproducibility and prognostic variability of grade and lamina propria invasion in stages Ta, T1 urothelial carcinoma of the bladder. J Urology 2003;169:1291–4.14. Tosoni I., Wagner U., Sauter G. et al. Clinical significance of interobserver differences in the staging and grading of superficial bladder cancer. BJU International 2000;85:48–53.Tosoni I., Wagner U., Sauter G. et al. Clinical significance of interobserver differences in the staging and grading of superficial bladder cancer. BJU International 2000;85:48–53.15. Van Rhijn B.W.G., van der Kwast T.H., Kakiashvili T.H. et al. Pathological stage review is indicated in primary pT1 bladder cancer. BJU Int 2009;106:206–11.Van Rhijn B.W.G., van der Kwast T.H., Kakiashvili T.H. et al. Pathological stage review is indicated in primary pT1 bladder cancer. BJU Int 2009;106:206–11.16. Engers R. Reproducibility and reliability of tumor grading in urological neoplasms. World J Urol 2007;25:595–605.Engers R. Reproducibility and reliability of tumor grading in urological neoplasms. World J Urol 2007;25:595–605.17. May M., Brookman-Amissah S., Roigas J. et al Prognostic accuracy of individual uropathologists in noninvasive urinary bladder carcinoma: a multicentre study comparing the 1973 and 2004 World Health Organisation classifications. Eur Urol 2010;57:850–8.May M., Brookman-Amissah S., Roigas J. et al Prognostic accuracy of individual uropathologists in noninvasive urinary bladder carcinoma: a multicentre study comparing the 1973 and 2004 World Health Organisation classifications. Eur Urol 2010;57:850–8.18. Van Rhijn B.W., van Leenders G.J., Ooms B.C. et al.The pathologist's mean grade is constant and individualizes the prognostic value of bladder cancer grading. Eur Urol 2010;57:1052–7.Van Rhijn B.W., van Leenders G.J., Ooms B.C. et al.The pathologist's mean grade is constant and individualizes the prognostic value of bladder cancer grading. Eur Urol 2010;57:1052–7.19. Gonul II, Poyraz A., Unsal C. et al. Comparison of 1998 WHO/ISUP and 1973 WHO classifications for interobserver variability in grading of papillary urothelial neoplasms of the bladder. Pathological evaluation of 258 cases. Urol Int 2007;78:338–44.Gonul II, Poyraz A., Unsal C. et al. Comparison of 1998 WHO/ISUP and 1973 WHO classifications for interobserver variability in grading of papillary urothelial neoplasms of the bladder. Pathological evaluation of 258 cases. Urol Int 2007;78:338–44.20. Mikuz G. The reliability and reproducibility of the different classifications of bladder cancer. In: Haupmann S., Dietel M., Sorbrinho-Simoes M., edit. Surgical pathology update 2001. Berlin: ABWWissenschaftsverlag, 2001. P. 114–115.Mikuz G. The reliability and reproducibility of the different classifications of bladder cancer. In: Haupmann S., Dietel M., Sorbrinho-Simoes M., edit. Surgical pathology update 2001. Berlin: ABWWissenschaftsverlag, 2001. P. 114–115.21. Yorukoglu K., Tuna B., Dikicioglu E. et al. Reproducibility of the 1998 World Health Organization/International Society of Urologic Pathology classification of papillary urothelial neoplasms of the urinary Bladder. Virchows Arch 2003;443:734–40.Yorukoglu K., Tuna B., Dikicioglu E. et al. Reproducibility of the 1998 World Health Organization/International Society of Urologic Pathology classification of papillary urothelial neoplasms of the urinary Bladder. Virchows Arch 2003;443:734–40.22. Otto W., Denzinger S., Fritsche H.M. et al. The WHO classification of 1973 is more suitable than the WHO classification of 2004 for predicting survival in pT1 urothelial bladder cancer. BJU Int 2010;107:404–8.Otto W., Denzinger S., Fritsche H.M. et al. The WHO classification of 1973 is more suitable than the WHO classification of 2004 for predicting survival in pT1 urothelial bladder cancer. BJU Int 2010;107:404–8.