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Clinicopathologic features and prognostic significance of mixed (Low and high-grade) papillary urothelial carcinoma comparison with low and high-grade papillary urothelial carcinoma

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Abstract

The World Health Organization/International Society of Urological Pathology (2022 WHO/ISUP) classification categorizes noninvasive carcinomas based on the highest grade observed in a pathology sample. According to this classification, a lesion is classified as mixed-grade (MG) if the highest-grade component comprises less than 5% high-grade (HG) carcinoma [14]. This study included 160 cases of low-grade papillary urothelial carcinoma (LGUC) and 160 cases of HG papillary urothelial carcinoma (HGUC), selected randomly. In addition, 160 consecutive and unselected cases of MG papillary urothelial carcinoma (MGUC) were obtained from all bladder transurethral resection specimens diagnosed with papillary urothelial carcinoma between January 2007 and January 2021. The results of the multivariate analysis showed that histologic grade, invasion of the lamina propria, and the presence of carcinoma in situ at presentation were independent prognostic parameters regarding recurrence-free survival (p = 0.002; hazard ratio (HR) = 1.44, 95% confidence interval (CI) = 1.059–1.956, p = 0.02; and HR = 1.76, 95% CI = 1.159–2.684, p = 0.008, respectively). Histologic grade was the only independent prognostic parameter of disease-specific survival (DSS) (p < 0.001). Comparisons between non-muscle invasive (NMI) MGUC and NMI LGUC, as well as between NMI MGUC and NMI HGUC, revealed statistically significant differences in terms of DSS (HR = 0.07, 95% CI = 0.024–0.252, p < 0.001 and HR = 1.59, 95% CI = 1.023–2.460, p = 0.039, respectively). Our study findings demonstrate statistically significant differences regarding DSS between NMI MGUC and NMI HGUC, as well as between NMI MGUC and NMI LGUC. Therefore, we suggested that considering the presence of less than 5% MGUC as a separate category may be appropriate. However, it is important to validate our results in larger cohorts with longer follow-up periods to establish the clinical significance of MGUC and provide guidance for patient management.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Pathology Department, Medeniyet University Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Dr.Erkin Caddesi, Göztepe Prof. Dr. Süleyman Yalçın Şehir Hastanesi, Patoloji Laboratuarı, 34720, Kadıköy, Istanbul, Turkey

    Gozde Kir

  2. Pathology Department, Istanbul Medeniyet University Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Fahrettin Kerim Gökay Caddesi, 34722, Kadıköy, Istanbul, Turkey

    Gozde Ecem Cecikoglu

  3. Pathology Department, Umraniye Training and Research Hospital, Elmalıkent Mahallesi, Adem Yavuz Cad. No:1, 34764, Ümraniye, Istanbul, Turkey

    Cumhur Selcuk Topal

  4. Istanbul Medeniyet University, Dumlupınar D100 No: 98, 34720, Kadıköy, Istanbul, Turkey

    Muhammet Huseyin Sorkun

  5. Urology Department, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin City Hospital, Fahrettin Kerim Gökay Caddesi, Göztepe Prof. Dr. Süleyman Yalçın Şehir Hastanesi Patoloji Laboratuvarı, 34722, Kadıköy, Istanbul, Turkey

    Meftun Culpan & Asif Yildirim

  6. Urology Department, Umraniye Training and Research Hospital, Elmalıkent Mahallesi, Adem Yavuz Cad. No:1, 34764, Ümraniye, Istanbul, Turkey

    Ferhat Yakup Suceken & Hakan Karaca

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  1. Gozde Kir
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Contributions

Gozde Kir: Designed the research study, contributed essential reagents or tools, performed the research, reviewed and corrected manuscript

Gozde Ecem Cecikoglu: Analyzed the data, wrote the draft paper

Muhammet Huseyin Sorkun: Analyzed the data

Cumhur Selçuk Topal, Meftun Culpan, Ferhat Yakup Suceken, Hakan Karaca: Contributed essential reagents or tools

Asif Yıldırım: Reviewed and corrected manuscript

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Correspondence to Gozde Kir.

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Kir, G., Cecikoglu, G.E., Topal, C.S. et al. Clinicopathologic features and prognostic significance of mixed (Low and high-grade) papillary urothelial carcinoma comparison with low and high-grade papillary urothelial carcinoma. Virchows Arch 483, 621–634 (2023). https://doi.org/10.1007/s00428-023-03625-3

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