Search

Aims: The International Collaboration on Cancer Reporting (ICCR) has provided detailed data sets based upon the published reporting protocols of the Royal College of Pathologists, the Royal College of Pathologists of Australasia and the College of American Pathologists. Methods and results: The data set for carcinomas of renal tubular origin treated by nephrectomy was developed to provide a minimum structured reporting template suitable for international use, and incorporated recommendations from the 2012 Vancouver Consensus Conference of the International Society of Urological Pathology (ISUP) and the fourth edition of the World Health Organisation Bluebook on tumours of the urinary and male genital systems published in 2016. Reporting elements were divided into those, which are required and recommended components of the report. Required elements are: specimen laterality, operative procedure, attached structures, tumour focality, tumour dimension, tumour type, WHO/ISUP grade, sarcomatoid/rhabdoid morphology, tumour necrosis, extent of invasion, lymph node status, surgical margin status, AJCC TNM staging and co-existing pathology. Recommended reporting elements are: preoperative treatment, details of tissue removed for experimental purposes prior to submission, site of tumour(s) block identification key, extent of sarcomatoid and/or rhabdoid component, extent of necrosis, presence of tumour in renal vein wall, lymphovascular invasion and lymph node status (size of largest focus and extranodal extension). Conclusions: It is anticipated that the implementation of this data set in routine clinical practice will inform patient treatment as well as provide standardised information relating to outcome prediction. The harmonisation of data reporting should also facilitate international research collaborations. [ABSTRACT FROM AUTHOR]

Background: Evaluation of programmed cell death ligand 1 (PD‐L1) expression can be made on both resection specimens and diagnostic biopsies; however, more than 30% of patients with advanced non–small cell lung cancer (NSCLC) do not have adequate histologic material to perform PD‐L1 assays and require additional biopsies. In addition, in our practice, more than 16% of cases have cytological smears as the only available material. Our aim was to validate the PD‐L1 immunocytochemistry assay on cytological smears and compare its accuracy with the results obtained from tissue cores and whole tumor sections using the clinically relevant cutoff of 50%. Method: We compared the PD‐L1 staining results of cytological smears to those from tissue cores or whole sections in 50 and 53 NSCLC cases, respectively, using the SP263 assay after scanning hematoxylin and eosin slides. Results: We found an overall agreement of 90.6% between cytological smears and whole sections; specifically, we found absolute concordance between smears with PD‐L1 expressed in <10% and ≥50% of cells and whole sections with PD‐L1 expressed in <50% and ≥50% of cells, respectively. In addition, slightly lower diagnostic accuracy was found for the cytological smears in comparison with the tissue cores, but the difference was not statistically significant. We found excellent intraobserver and good interobserver agreement in the evaluation of PD‐L1 on smears. Conclusion: Immunocytochemistry on cytological smears is a reliable method for determination of PD‐L1 at the 50% cutoff when positive cells are <10% or ≥50%; for cases showing PD‐L1 expression in 10% to 49% of cells, additional tissue sampling may be necessary. Immunocytochemistry on cytological smears is a reliable method for determination of the programmed cell death 1 ligand (PD‐L1) at the 50% cutoff when positive cells are <10% or ≥50%. For cases showing PD‐L1 expression in 10% to 49% of cells, additional tissue sampling may be necessary. [ABSTRACT FROM AUTHOR]

Aims Fumarate hydratase ( FH)-deficient renal cell carcinoma ( RCC) is a high-grade, aggressive tubulopapillary carcinoma, arising predominantly in the setting of the hereditary leiomyomatosis- RCC syndrome of familial uterocutaneous leiomyomatosis and deficiency of FH. In contrast, succinate dehydrogenase ( SDH)-deficient RCC is a lower-grade oncocytic carcinoma with cytoplasmic flocculence/vacuolation and inclusions, arising mostly in individuals harbouring germline mutations of subunit B of the SDH complex ( SDHB). Herein we aim to report the clinicopathologic features of a novel form of FH-deficient RCC showing a low grade oncocytic morphology, reminiscent of SDH-deficient RCC. Methods and results These distinctive, low-grade oncocytic neoplasms, with solid, nested and focally tubular architecture (2-90 mm), arose in four males (aged 11-41 years). Uniform cytology of polygonal cells, with flocculent, vacuolated eosinophilic cytoplasm with scattered inclusions, fine chromatin, and inconspicuous nucleoli, was apparent. Despite these features suggestive of SDH-deficient RCC, each tumour was confirmed as an FH-deficient carcinoma with retained SDHB expression. One case showed a synchronous, anatomically separate, typical high-grade FH-deficient RCC; one other showed such a tumour at nephrectomy 4 years later. No progression has been noted at 3 and 7 years in the cases with only the SDH-like lesions; the two cases with separate, typical FH-deficient RCCs progressed. Conclusions In summary, we characterize a novel oncocytic type of FH-deficient RCC with a striking resemblance to SDH-deficient RCC, posing a diagnostic challenge and raising concerns about sampling and multifocality for syndrome-associated cases under surveillance protocols. [ABSTRACT FROM AUTHOR]

We describe a rare multicentric neoplastic disease arising bilteraly in the kidney. The patient was a 70-year-old man, who, during a period of 3 years, was treated for five independent tumors of three histotypes (three multilocular cystic clear cell renal cell neoplasms of low malignant potential, one clear cell renal cell carcinoma, and one clear cell papillary renal cell carcinoma, respectively). Pathologic diagnosis of the reported tumors was confirmed by immunohistochemical analyses, including CD10, CA IX, CK7, AMACR/RACEMASE, and 34 beta E12. Molecular detection of KRAS, BRAF, NRAS, PIK3CA, ALK, ERBB2, DDR2, MAP2K1, RET, and EGFR gene mutational analysis was also performed in all tumors. [ABSTRACT FROM AUTHOR]

Grading is an important prognostic parameter for prostate adenocarcinoma and renal cell carcinoma ( RCC); however, the most frequently used classifications fail to account for advances in our understanding of the diagnostic features, classification and/or behaviour of these tumours. In 2005 and 2014, the International Society of Urological Pathology ( ISUP) proposed changes to Gleason scoring with the adoption of the ISUP grading for prostate cancer in 2014 (grade 1, score 3 + 3; grade 2, score 3 + 4; grade 3, score 4 + 3; grade 4, score 8; grade 5, score 9-10). Internationally the Fuhrman grading system is widely employed despite criticisms related to its application, validity, and reproducibility. In 2012, the ISUP established a grading system for RCC (grade 1, the nucleolus is not seen or is inconspicuous and basophilic at ×400 magnification; grade 2, nucleoli are eosinophilic and clearly visible at ×400 magnification; grade 3, nucleoli are clearly visible at ×100 magnification; grade 4, tumours show extreme pleomorphism or rhabdoid and/or sarcomatoid morphology). This grading has been validated for clear cell RCC and papillary RCC. It was further recommended that chromophobe RCC not be graded. For other morphotypes of RCC, ISUP grading has not been validated as a prognostic parameter, but can be used for descriptive purposes. [ABSTRACT FROM AUTHOR]

The use of percutaneous renal tumour biopsy (RTB) as a diagnostic tool for the histological characterization of renal masses has increased dramatically within the last 30 years. This increased utilization has paralleled advances in imaging techniques and an evolving knowledge of the clinical value of nephron sparing surgery. Improved biopsy techniques using image guidance, coupled with the use of smaller gauge needles has led to a decrease in complication rates. Reports from series containing a large number of cases have shown the non-diagnostic rate of RTB to range from 4% to 21%. Re-biopsy has been shown to reduce this rate, while the use of molecular markers further improves diagnostic sensitivity. In parallel with refinements of the biopsy procedure, there has been a rapid expansion in our understanding of the complexity of renal cell neoplasia. The 2013 Vancouver Classification is the current classification for renal tumours, and contains five additional entities recognized as novel forms of renal malignancy. The diagnosis of tumour morphotype on RTB is usually achievable on routine histology; however, immunohistochemical studies may be of assistance in difficult cases. The morphology of the main tumour subtypes, based upon the Vancouver Classification, is described and differentiating features are discussed. [ABSTRACT FROM AUTHOR]

Aims To study clear cell renal cell carcinomas with predominant cystic and sclerotic components, in which a solid epithelial component precluded a diagnosis of multilocular cystic renal cell carcinoma. We designated these tumours 'cystic partially regressed clear cell renal cell carcinoma.' Methods and results Twenty-seven tumours were studied, from patients with a median age of 58 years; the stage was most often p T1 (89%). The Fuhrman grade was 2 (48%), 1 (33%), or 3 (19%). The solid epithelial component constituted up to 30% of the tumour volume (median, 10%), whereas the cystic component constituted 15-80% (median, 65%), and the sclerotic component 10-70% (median, 20%). Thin fibrovascular septa lined by cells with clear cytoplasm were almost always present, resembling multilocular cystic renal cell carcinoma. Both zones of sclerosis and fibrovascular septa often contained inconspicuous epithelial cells. Sclerotic areas ranged in appearance from a cellular fibroblastic reaction to scar-like with a residual network of capillaries resembling haemangioma. No patient developed recurrence or metastasis. Conclusions Cystic partially regressed clear cell renal cell carcinoma is an uncommon pattern of clear cell renal cell carcinoma, being composed of cysts with solid epithelial and sclerotic components that differentiate it from multilocular cystic renal cell carcinoma. [ABSTRACT FROM AUTHOR]

Study Type - Outcomes (cohort) Level of Evidence 2b What's known on the subject? and What does the study add? About 80% of RCCs have clear cell histology, and consistent data are available about the clinical and histological characteristics of this histological subtype. Conversely, less attention has been dedicated to the study of non-clear cell renal tumours Specifically, published data show that chromophobe RCC (ChRCC) have often favourable pathological stages and better nuclear grades as well as a lower risk of metastasizing compared with clear cell RCC (ccRCC). Patients with ChRCC were shown to have significantly higher cancer-specific survival (CSS) probabilities compared with ccRCC. However, an independent prognostic role of RCC histotype was not confirmed in some large multicenter series and only a few studies have focused on the oncological outcomes of ChRCC. The present study is one of the few to evaluate cancer-related outcomes of ChRCC and represents to our knowledge the largest series of ChRCCs. Consequently, the present findings may assist in elucidating the natural history of surgically treated ChRCC. The present study confirms that ChRCCs have good prognosis and a low tendency to progress and metastasize. Only 1.3% of patients presented with distant metastases at diagnosis, and the 5- and 10-year CSS were 93% and 88.9%, respectively. However, although ChRCCs are generally characterised by an excellent prognosis, we observed that patients with locally advanced or metastatic cancers as well as those with sarcomatoid differentiation have a poor outcome. The study also investigated prognostic factors for recurrence-free survival (RFS) and CSS for this RCC histotype. The definition of outcome predictors can be useful for patient counselling, planning of follow-up strategies, and patient selection for clinical trials. In the present study, gender, clinical T stage, pathological T stage, and presence of sarcomatoid differentiation were significantly associated with RFS and CSS at multivariable analysis. We also identified N/M stage as an independent predictor of CSS. Notably, as Fuhrman grade was not an independent predictor of cancer-related outcomes, the present study confirms that this histological variable is not a reliable prognostic factor for ChRCC. OBJECTIVES To investigate cancer-related outcomes of chromophobe renal cell carcinoma (ChRCC) in a large multicentre dataset., To determine prognostic factors for recurrence-free survival (RFS) and cancer-specific survival (CSS) for this RCC histological type., PATIENTS AND METHODS In all, 291 patients with ChRCC were identified from a multi-institutional retrospective database including 5463 patients who were surgically treated for RCC at 16 Italian academic centres between 1995 and 2007., Univariable and multivariable Cox regression models were used to identify prognostic factors predictive of RFS and CSS after surgery for ChRCC., RESULTS At a median follow-up of 44 months, 25 patients (8.6%) had disease recurrence and 18 patients (6.2%) died from disease., The 5-year RFS and CSS rates were 89.3% and 93%, respectively., Gender ( P= 0.014), clinical T stage ( P= 0.017), pathological T stage ( P= 0.003), and sarcomatoid differentiation ( P= 0.032) were independent predictors of RFS at multivariable analysis., For CSS, there was an independent prognostic role for gender ( P= 0.032) and T stage ( P= 0.019) among the clinical variables and for T stage ( P= 0.016), N/M stage ( P= 0.023), and sarcomatoid differentiation ( P= 0.015) among the pathological variables., CONCLUSIONS Patients with ChRCC have a low risk of tumour progression, metastasis, and cancer-specific death., Patient gender, clinical and pathological tumour stage, and sarcomatoid differentiation are significant predictors of RFS and CSS for ChRCC. [ABSTRACT FROM AUTHOR]

Brunello E, Brunelli M, Manfrin E, Nottegar A, Bersani S, Vergine M, Molino A, Fiorio E, Chilosi M, Gobbo S, Martignoni G & Bonetti F (2012) Histopathology 60, 482-488 Classical lobular breast carcinoma consistently lacks topoisomerase-IIα gene amplification: implications for the tailored use of anthracycline-based chemotherapies [Correction added after online publication, 17 January 2012: Title amended to match main article title.] Aims: There is consistent lack of data focusing the topoisomerase-IIα gene status in lobular breast carcinoma, a subtype that usually shows poor responsiveness to chemotherapies including those using anthracycline drugs. Methods and results: Forty-six infiltrative lobular carcinomas, 13 with matched metastases, were used. Topoisomerase-IIα gene amplification was evaluated by chromogenic in situ hybridization (CISH) and fluorescence in situ hybridization (FISH). We also assessed Her2/neu status by CISH, FISH and silver in situ hybridization (SISH). HER2 immunoexpression was assessed by the HercepTest. Forty-four of 46 (95%) cases revealed no topoisomerase-IIα amplification, whereas two of 46 (5%) cases were amplified by all three techniques. Eleven of the 13 metastatic sites showed no amplification either in the primary or in the metastases (85%); the remaining two were amplified (15%). Her2/neu was not amplified in 44 of 46 (95%) cases nor was it amplified in 11 of 13 (95%) metastatic tissues. The two cases showing Her2/neu and topoisomerase-IIα amplification scored 3+; the remaining non-amplified cases scored 0 or 1+ in 40 and 2+ in four cases. Conclusions: In the era of personalized and tailored therapies, we suggest that patients affected by the classical lobular subtype of breast carcinoma constantly lack the ad hoc predictive rationale for receiving common chemotherapy that includes anthracyclines. [ABSTRACT FROM AUTHOR]

Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? The differential effect of ethnicity on clinico-pathological features and cancer-related outcomes remains uninvestigated in upper tract urothelial carcinoma. Ethnicity was not an independent predictor of either recurrence or cancer-related death in upper tract urothelial carcinoma. OBJECTIVE • To assess the impact of differences in ethnicity on clinico-pathological characteristics and outcomes of patients with upper urinary tract urothelial carcinoma (UTUC) in a large multi-center series of patients treated with radical nephroureterectomy (RNU). MATERIALS AND METHODS • We retrospectively collected the data of 2163 patients treated with RNU at 20 academic centres in America, Asia, and Europe. • Univariable and multivariable Cox regression models addressed recurrence-free survival (RFS) and cancer-specific survival (CSS). RESULTS • In all, 1794 (83%) patients were Caucasian and 369 (17%) were Japanese. All the main clinical and pathological features were significantly different between the two ethnicities. • The median follow-up of the whole cohort was 36 months. At last follow-up, 554 patients (26%) developed disease recurrence and 461 (21%) were dead from UTUC. • The 5-year RFS and CSS estimates were 71.5% and 74.2%, respectively, for Caucasian patients compared with 68.8% and 75.4%, respectively, for Japanese patients. • On univariable Cox regression analyses, ethnicity was not significantly associated with either RFS ( P= 0.231) or CSS ( P= 0.752). • On multivariable Cox regression analyses that adjusted for the effects of age, gender, surgical type, T stage, grade, tumour architecture, presence of concomitant carcinoma in situ, lymphovascular invasion, tumour necrosis, and lymph node status, ethnicity was not associated with either RFS (hazard ratio [HR] 1.1; P= 0.447) or CSS (HR 1.0; P= 0.908). CONCLUSIONS • There were major differences in the clinico-pathological characteristics of Caucasian and Japanese patients. • However, RFS and CSS probabilities were not affected by ethnicity and race was not an independent predictor of either recurrence or cancer-related death. [ABSTRACT FROM AUTHOR]

The article discusses the intervention of human growth factor receptor 2 (HER2) in lobular breast carcinoma treatment. It examines the use of ASCO/CAP guidelines in assessing the treatment of breast carcinoma. It mentions the therapeutic management in patients established by HER2 as well as the biological characteristics of tumour. It proposes the essential of HER2 in patients who are suitable for receiving trastuzumab therapy through ASCO/CAP.

Sister Mary Joseph’s nodule (SMJN) involving the umbilicus can often be a clinical sign of metastatic cancer, but rarely cancer originating from the breast. We report a rare case of umbilical metastases from breast cancer and reviewed the literature. A 54-year-old woman was referred to a pre-surgery clinic for an examination of an umbilical nodule. The patient had a history of ductal breast carcinoma. Cytological smear from fine needle aspiration showed epithelial neoplastic cells resembling those of breast carcinoma. Neoplastic cells from tissue were positive for cytokeratin 8–18, estrogen and progesterone receptor and negative for E-cadherin and had a low proliferative index. Her-2/neu immunodetection showed a 2+ equivocal positive rate, but Her-2/neu gene amplification was found on the cytological smear by fluorescence in situ hybridization analysis. Similar results were obtained within a tissue section. Concordant findings have been obtained when comparing the recent American Society of Clinical Oncology/College of American Pathologists scoring system. Fine needle aspiration from the SMJN is a useful tool for the diagnosis of metastatic breast cancer. Furthermore, the predictive biomarkers for tumors of the breast, hormonal receptors and Her-2/neu not only assist with the identification of the source of the metastatic disease but also provide clinical information for patient management. [ABSTRACT FROM AUTHOR]

Objectives: To identify the variables predictive of contralateral metachronous upper urinary tract transitional cell carcinoma (UUT-TCC) after nephroureterectomy (NFU) for non-metastatic UUT-TCC. Methods: Clinical and pathological data of 234 patients who had undergone NFU for UUT-TCC from 1989 to 2005 in three European urological centers were retrospectively collected and analyzed. Results: The median follow-up duration for the whole cohort was 34 months. Contralateral metachronous UUT-TCC was detected in 14 patients (6%). Three patients were treated by NFU, while seven patients underwent ureterectomy and reimplantation and four patients were treated by endoscopic resection plus bacillus Calmette–Guérin instillations within the UUT through a nephrostomic tube. On univariate analysis, a prior history of bladder TCC before NFU was the only factor predictive of the occurrence of contralateral UUT-TCC. Specifically, the 5-year probabilities of being free from contralateral UUT-TCC were 96.6% for the patients with de novo UUT-TCC, and 91.1% and 55.3% for those having non-muscle-invasive and muscle invasive bladder TCC before the UUT cancer, respectively. All survival differences were statistically significant (no history of bladder TCC vs history of non-muscle-invasive bladder TCC, log rank P value 0.015; history of non-muscle-invasive bladder TCC vs history of muscle-invasive bladder TCC, log rank P value 0.035). Conclusions: In our multicenter dataset of patients who had undergone NFU for UUT-TCC, contralateral metachronous UUT-TCC occurred in 6% of the patients. A prior history of bladder TCC before NFU was the only variable predictive of UUT recurrence at univariate analysis. [ABSTRACT FROM AUTHOR]

OBJECTIVE To compare the prognostic accuracy of the two most used integrated staging systems to predict the outcome of patients with clear cell renal cell carcinoma (RCC). PATIENTS AND METHODS We retrospectively evaluated the clinical and pathological data of 388 patients surgically treated for clear cell RCC between 1986 and 2000. The pathological slides of all specimens were reviewed by a pathologist unaware of patient outcome. All patients were classified according to the ‘Stage, Size, Grade and Necrosis’ (SSIGN) score and University of California Los Angeles Integrated Staging System (UISS) model, and the predictive accuracy of the two models was evaluated using receiver operating characteristics (ROC) curves. RESULTS The median follow-up was 56 months; the 10-year cancer-specific survival (CSS) probabilities according to the SSIGN score were 96% in the ‘0–2’ category, 78% in the ‘3–4’, 43% in the ‘5–6’, 25.8% in the ‘7–9’ and 0% in the ‘≥10’ group ( P < 0.001). According to the UISS, in nonmetastatic patients the 10-year CSS probabilities were 100% in low, 73% in intermediate and 62% in high-risk groups; in metastatic patients the respective CSS probabilities were 37%, 33% and 12.5% ( P < 0.001). The area under the ROC curve (AUC) was 0.870 for the SSIGN score and 0.832 for the UISS. Including only nonmetastatic patients in the analysis, the AUC was 0.830 for the SSIGN score and 0.760 for the UISS model. CONCLUSION Our study shows for the first time that the SSIGN score offers a better stratification of clear cell RCC than the UISS model. These data should be considered in the design of future randomized controlled trials. [ABSTRACT FROM AUTHOR]

OBJECTIVE To identify the prognostic factors predictive of metachronous bladder transitional cell carcinoma (TCC) in a multi-institutional dataset of patients who had undergone nephroureterectomy (NU) for nonmetastatic upper urinary tract (UUT) TCC. PATIENTS AND METHODS The clinical and pathological data of 231 patients who had had NU for UUT-TCC from 1989 to 2005 in three European centres were collected retrospectively, and analysed for clinical and pathological variables. RESULTS The median follow-up was 38 months; during the follow-up, bladder TCC was detected in 109 patients (47.2%), and was significantly more common in patients who had UUT-TCC after previous bladder TCC ( P < 0.001), in those with ureteric cancer ( P = 0.022), and in those with pT2 UUT-TCC ( P = 0.017). On multivariate analysis, a previous history of bladder TCC was the only independent predictor of metachronous bladder TCC (hazard ratio 2.825; P < 0.001). The 5-year probability of being free from metachronous bladder TCC was 45.5%. A history of bladder TCC ( P < 0.001) and UUT tumour site ( P = 0.01) were significantly associated with the probability of bladder recurrence-free survival. On multivariate analyses, a previous history of bladder TCC (hazard ratio 2.226; P < 0.001) and the presence of ureteric TCC (1.562; P = 0.036) were independent predictors of the probabilities of being free from metachronous bladder TCC. CONCLUSION In this multi-institutional study of patients who had had NU for UUT-TCC, a history of bladder TCC was the only independent predictor of metachronous bladder TCC, while both a history of bladder TCC and the presence of ureteric tumours were predictive of the probabilities of being free from metachronous bladder TCC. [ABSTRACT FROM AUTHOR]

The article focuses on a study on the predictors of cancer-specific survival in patients with nonmetastatic transitional cell carcinoma of the upper urinary tract. The study involved hundreds of patients who underwent nephroureterectomy and concomitant cystectomy for synchronous muscle-invasive bladder cancer. Log-rank test and Cox proportional-hazards regression models were used for univariate and multivariate analyses. The study concludes that pathologic stage of the primary tumor and lymph nodes is among the predictors.

OBJECTIVE To assess the short-term outcome in patients with high-risk prostate cancer treated by transrectal high-intensity focused ultrasound (HIFU). PATIENTS AND METHODS From April 2003 to November 2004, 30 patients with high-risk prostate cancer were enrolled in this prospective study; all had transurethral resection of the prostate before transrectal HIFU treatment, using the Ablatherm device (EDAP, Lyon, France) during the same session, associated with hormonal therapy with luteinizing hormone-releasing hormone analogues. After the procedure, all the patients were evaluated every 3 months by physical examination, prostate-specific antigen (PSA) assay and a continence questionnaire. The follow-up schedule also included a transperineal prostate biopsy 6 months after the treatment. All the patients had a minimum follow-up of 12 months. RESULTS The HIFU treatment took a median (interquartile range, IQR) of 140 (100–160) min. No complications were reported during treatment. The mean (IQR) hospitalization was 2.2 (1–4) days, and the suprapubic drainage tube was removed after 12 (7–18) days. The complications after treatment were: urinary tract infections in five patients (16%), stenosis of the intraprostatic and membranous urethra in three (10%), and secondary infravesical obstruction in four (13%). At 12 months after the procedure, 28 patients (93%) were continent. Seven of the 30 men (23%) had a positive prostate biopsy. At the 1-year follow-up only three of the 30 patients with high-risk prostate cancer had a PSA level of >0.3 ng/mL. CONCLUSIONS HIFU is a modern, minimally invasive therapy for prostate cancer, often used in selected patients with localized disease. The present results show that HIFU was also feasible in patients with high-risk prostate cancer. The low complication rates and favourable functional outcome support the planning of further larger studies in such patients. The oncological efficacy of HIFU should be assessed in further studies with a longer follow-up. [ABSTRACT FROM AUTHOR]

The article comments on the article "The World Health Organization 1973 classification system for grade is an important prognosticator in T1 non-muscle-invasive bladder cancer" by E.E.F. van de Putte and others. It mentions that conservative treatment of Stage pT1 bladder carcinomas (BCs) with BCG instillation and intravesical chemotherapy may lead to disease progression and death, while radical cystectomy is effective for patients with tumours that may have low potential for progression.

A response by Brett Delahunt et al. to a letter to the editor about their article "Gleason and Fuhrman No Longer Make the Grade" in the 2015 issue is presented.

Study Type - Prognosis cohort series (multi-centre) Level of Evidence 2b What's known on the subject? and What does the study add? The relatively low prevalence of papillary RCC and the limited number of patients enrolled in most of the surgical series limit meaningful conclusions with respect to cancer-related outcome and independent prognostic information. Patients with papillary RCC have relatively a low risk of tumour recurrence and cancer-related death after surgery. Pathological lymph node stage, presence of metastases and Fuhrman nuclear grade were the main independent predictors of cancer-related outcomes, whereas only a non-statistically significant trend was found for the 2009 pathological T stage. OBJECTIVES [ABSTRACT FROM AUTHOR]