三级的重要性：原发性非肌层浸润性膀胱癌三级混合分类系统的诉求。
The Importance of Being Grade 3: A Plea for a Three-tier Hybrid Classification System for Grade in Primary Non-muscle-invasive Bladder Cancer.
发表日期：2024 Aug 28
作者：
Irene J Beijert, Oskar Hagberg, Truls Gårdmark, Lars Holmberg, Christel Häggström, Allan Johnston, Matthew Trail, Sami Hamid, Barend A Dreyer, Luisa Padovani, Roberta Garau, Rami Hasan, Imran Ahmad, David Hendry, Eva M Compérat, Maximilian Burger, Morgan Rouprêt, Paolo Gontero, Maria J Ribal, Theo H van der Kwast, Marko Babjuk, Richard J Sylvester, Paramananthan Mariappan, Fredrik Liedberg, Bas W G van Rhijn, , , ,
来源：
EUROPEAN UROLOGY
摘要：
分级是非肌层浸润性膀胱癌进展的重要决定因素。尽管推荐使用世界卫生组织（WHO）2004/2016分级系统，但其他系统如WHO1973和WHO1999仍然被广泛使用。最近，提出了一种混合（三层）系统，将WHO2004/2016高等级（HG）分为HG/2级（G2）和HG/G3，同时保持低等级。我们评估了 HG/G3 和 HG/G2 的预后表现。对包含 9712 个原发性（首次诊断）Ta-T1 膀胱肿瘤的三个独立队列进行了分析。使用累积发生函数和Cox回归模型分析进展时间。 Harrell 的 C 指数用于评估歧视。在多变量分析中，HG/G3 的进展时间明显短于 HG/G2（队列 1：风险比 [HR] = 1.92；队列 2：HR = 2.51；队列 3：HR = 1.69）。 HG/G3 的 5 年相应进展风险分别为 18%、20% 和 18%，而 HG/G2 的相应进展风险分别为 7.3%、7.5% 和 9.3%。使用混合等级的 Cox 模型比使用 WHO2004/2016 的模型表现更好（所有队列；p < 0.001）。对于这三个队列，WHO2004/2016 年的 C 指数分别为 0.69、0.62 和 0.75，而混合级别的 C 指数分别为 0.74、0.68 和 0.78。将 HG 类别细分为 HG/G2 和 HG/G3，对进展时间进行分层，并支持对 Ta/T1 膀胱癌采用混合分级系统的建议。版权所有 © 2024 作者。由 Elsevier B.V. 出版。保留所有权利。
Grade is an important determinant of progression in non-muscle-invasive bladder cancer. Although the World Health Organization (WHO) 2004/2016 grading system is recommended, other systems such as WHO1973 and WHO1999 are still widely used. Recently, a hybrid (three-tier) system was proposed, separating WHO2004/2016 high grade (HG) into HG/grade 2 (G2) and HG/G3 while maintaining low grade. We assessed the prognostic performance of HG/G3 and HG/G2. Three independent cohorts with 9712 primary (first diagnosis) Ta-T1 bladder tumors were analyzed. Time to progression was analyzed with cumulative incidence functions and Cox regression models. Harrell's C-index was used to assess discrimination. Time to progression was significantly shorter for HG/G3 than for HG/G2 in multivariable analyses (cohort 1: hazard ratio [HR] = 1.92; cohort 2: HR = 2.51, and cohort 3: HR = 1.69). Corresponding progression risks at 5 yr were 18%, 20%, and 18% for HG/G3 versus 7.3%, 7.5%, and 9.3% for HG/G2, respectively. Cox models using hybrid grade performed better than models with WHO2004/2016 (all cohorts; p < 0.001). For the three cohorts, C-indices for WHO2004/2016 were 0.69, 0.62, and 0.75, while, for hybrid grade, C-indices were 0.74, 0.68, and 0.78, respectively. Subdividing the HG category into HG/G2 and HG/G3 stratifies time to progression and supports the recommendation to adopt the hybrid grading system for Ta/T1 bladder cancers.Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.