[MOL] Grading of urothelial carcinoma..... [02269] Medicine On Line

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[MOL] Grading of urothelial carcinoma.....

A DGReview of :"Cancer heterogeneity and its biologic implications in the grading of urothelial carcinoma"

By James Adams

A new method of grading urothelial cancer growth helps divide patients into prognostically significant groups, according to a new study.

Investigators used the newly proposed World Health Organization and International Society of Urological Pathology (WHO/ISUP) histologic grading system to assign values to the cancer growth patterns of 164 patients diagnosed with urothelial carcinoma at the Mayo Clinic between 1985 and 1986.

Because urothelial carcinoma of the bladder often contains heterogeneous areas of cancer growth, both the most common (primary) and second most common (secondary) patterns of growth were graded in each patient using the WHO/ISUP. A score of one was given for urothelial neoplasms of low malignant potential, a score of two for low grade urothelial carcinoma, and a score of three for high grade urothelial carcinoma.

Disease progression-defined as the development of invasive carcinoma, distant metastasis, or death due to bladder carcinoma-was monitored for a mean follow-up period of 7.7. years.

Results showed that the worst score, the primary score, the secondary score, and the combined value of the primary and secondary scores all could significantly predict progression of the disease, with the combined score apparently being the most accurate. Patients with combined scores of two, three, four, five, and six had survival rates of 93, 80, 82, 68, and 40 per cent, respectively.

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