A simplified grading method of transitional cell carcinoma of the urinary bladder: reproducibility, clinical significance and comparison with other prognostic parameters

Br J Urol. 1994 Jun;73(6):625-31. doi: 10.1111/j.1464-410x.1994.tb07546.x.


Objective: To determine the extent to which the biological potential of transitional cell neoplasms can be predicted by histological grading of the primary tumour in a two grade system using simple histological criteria and to evaluate the additional value of grading when combined with other prognostic factors. The inter-observer variability of the World Health Organization grading and the two grade system was tested.

Patients and methods: The study included 311 patients with newly diagnosed transitional cell carcinoma of the urinary bladder. Two-hundred and fifty-six patients (82.3%) were men and 55 (17.7%) were women. Age ranged from 17 to 92 years with a mean of 66 years. The median follow-up was 38 months, with a maximum of 150 months (mean 46.2 months).

Results: A simplified grading system was developed in which only low-grade and high-grade tumours were distinguished. Reproducibility of this grading system was good to excellent with a group kappa value of 0.78. The survival of patients with low-grade tumours was significantly better than that of patients with high-grade tumours (P < 0.0001). The progression-free interval was also significantly longer in patients with low-grade tumours than in patients with high-grade tumours (P = 0.0032). Combining low-high grading, histological stage, mitotic index and age, histological stage appeared to be the most important parameter in predicting survival and progression.

Conclusion: A reproducible and discriminating system such as this low-high grade system is an important prognostic factor when stage cannot be established with certainty.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Transitional Cell / mortality
  • Carcinoma, Transitional Cell / pathology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mitotic Index
  • Neoplasm Staging
  • Observer Variation
  • Prognosis
  • Prospective Studies
  • Reproducibility of Results
  • Urinary Bladder Neoplasms / mortality
  • Urinary Bladder Neoplasms / pathology*