Evidence map›Paper›PMID 41264026›Full record

ArticleWorld journal of urology2025

Is histological grade a useful parameter in muscle-invasive urothelial bladder cancer? Results from a multicenter study on the impact of different grading systems on disease-free survival after upfront radical cystectomy.

Emily Rinderknecht, Francesco Claps, Peter J Bostrom, Shahrokh F Shariat, Yann Neuzillet, Alexandre R Zlotta, Carlo Trombetta, Markus Eckstein, Renee A G Lijnen, Laura S Mertens and 14 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in World journal of urology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

24 authors.

Emily RinderknechtDepartment of Urology, Caritas St. Josef Medical Center, University of Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany. emily.rinderknecht@ukr.de.ORCID http://orcid.org/0009-0002-7283-5237
Francesco ClapsDepartment of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Peter J BostromDepartment of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada.
Shahrokh F ShariatDepartment of Urology, University of Texas Southwestern Medical center, Dallas, TX, USA.
Yann NeuzilletDepartment of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Alexandre R ZlottaDepartment of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada.
Carlo TrombettaDepartment of Medicine, Surgery and Health Sciences, Urological Clinic, University of Trieste, Trieste, Italy.
Markus EcksteinInstitute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
Renee A G LijnenDepartment of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Laura S MertensDepartment of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Rossana BussaniDepartment of Pathology, University of Trieste, Trieste, Italy.
Maximilian BurgerDepartment of Urology, Caritas St. Josef Medical Center, University of Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany.
Geert J L H van LeendersDepartment of Pathology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands.
Joost L BoormansDepartment of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands.
Bernd WullichDepartment of Urology & Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen- Nürnberg, Erlangen, Germany.
Arndt HartmannInstitute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
Nicola PavanDepartment of Precision Medicine in Medical, Surgical and Critical Care, Urological Clinic, University of Palermo, Palermo, Italy.
Damien PouesselDepartment of Medical Oncology, Oncopole Claudius Regaud, Toulouse University Cancer Center (IUCT) Oncopole, Toulouse, F-31000, France.
Theo H van der KwastToronto and Laboratory Medicine and Pathobiology, Princess Margaret Cancer Center, University of Toronto, Toronto, Canada.
Yves AlloryMolecular Oncology team, Institut Curie, CNRS, UMR144, PSL Research University, Paris, F-75005, France.
Tahlita C M ZuiverloonDepartment of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands.
Yair LotanDepartment of Urology, University of Texas Southwestern Medical center, Dallas, TX, USA.
Bas W G van Rhijn *Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany.
Roman Mayr *Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThe prognostic value of histopathological grade in muscle-invasive urothelial carcinoma (MIBC) to predict disease-specific survival (DSS) is understudied. While grading systems like WHO1973 and WHO2004 are established in non-muscle-invasive bladder cancer (NMIBC), their relevance in MIBC remains controversial. This study assessed the prognostic impact of histopathological grade on DSS in a multicenter cohort.

methodsWe included 1,123 cN0M0 MIBC patients treated with upfront radical cystectomy (1987–2020) at nine centers. Tumors were graded using WHO1973 (G1 + G2 combined as G1/2 due to low numbers vs. G3), WHO2004 (low-grade [LG] vs. high-grade [HG]), and a hybrid three-tier system. Slides were locally reviewed by uro-pathologists. DSS was analyzed using Kaplan-Meier and Cox models, adjusting for age, stage, lympho-vascular invasion, surgical margins, lymph-node status, adjuvant chemotherapy, treatment center, and era of cystectomy.

resultsAmong all cases, 74 (6.6%) were G1/2 and 1,049 (93.4%) G3; 27 (2.4%) were LG and 1,096 (97.6%) HG. Median follow-up was 5.3 years (IQR 2.9–8.5). Univariable analyses showed significantly better DSS for LG and G1/2 tumors across grading systems. However, multivariable models showed no independent association between grade and DSS.

conclusionAlthough LG and G1/2 MIBC tumors demonstrated superior DSS in univariable analyses, the lack of independent prognostic significance in multivariable models questions the relevance of histopathological grade in MIBC. Further studies should explore the clinical utility of grade, define new grading schemes including features of epithelial-mesenchymal transition or tumor microenvironment, and explore alternative prognostic (bio)markers.

Indexed as

Carcinoma, Transitional CellCystectomyUrinary Bladder NeoplasmsAgedDisease-Free SurvivalFemaleHumansMaleMiddle AgedNeoplasm GradingNeoplasm InvasivenessPrognosisRetrospective StudiesHistopathological gradeRadical cystectomyUrothelial carcinomaUrothelial neoplasmWHO1973 classificationWHO2004 classification

Identifiers

PMID41264026
PMCPMC12634793

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.