Prognosis and tumor grading in bladder urothelial carcinomas with intratumoral grade heterogeneity
In brief
Bladder tumors with 27.5% high-grade tissue marked poorer survival
In this retrospective study of 180 non-muscle-invasive bladder tumors with mixed grades, survival worsened as the high-grade share increased, with 27.5% identified as a threshold linked to poorer prognosis. The proportion was not associated with recurrence, and tumor size and extent still matter, so the finding supports further evidence before changing grading practice.
- Journal
- Pathology oncology research : POR (Q2)
- Published
- 5 October 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Gökhan Veli Alkan, Kutsal Doğan, Meltem Türk Alkan, Evrim Önder
- PMID
- 42898355
- DOI
- 10.3389/pore.2026.1612553
Why clinicians should know about it
- Picked for Pathology and Forensic Medicine (top studies of the week, 25 October 2026): Directly evaluates grading thresholds and prognostic impact
Abstract
AIMS: Grade heterogeneity is one of the most debated issues in the grading of urothelial carcinomas. The 2022 WHO classification states that approximately one-third of urothelial carcinomas exhibit grade heterogeneity and suggests that the presence of ≥5% high-grade component may justify classification as high-grade. Nevertheless, the need for further evidence was also emphasized. This study aimed to evaluate the prognostic impact of the high-grade component in urothelial carcinomas with grade heterogeneity and to determine a threshold value for high-grade proportion that is clinically meaningful for grading. METHODS: This retrospective study included 180 cases of non-muscle-invasive urothelial carcinoma with grade heterogeneity, diagnosed between January 2019 and August 2022 on TUR specimens, with available clinical data. Recurrence and survival time were assessed. Cases with >90% high-grade component were excluded. RESULTS: Recurrence was observed in 26.7% of cases. The two-year survival rate was 73.3%. While no significant association was found between recurrence and the proportion of high-grade component, survival time significantly decreased as the proportion of high-grade component increased. ROC curve analysis identified 27.5% as the cut-off value associated with adverse prognosis. CONCLUSION: In non-muscle-invasive urothelial carcinomas, the proportion of high-grade component showed a strong association with survival. Together with literature findings, our results suggest that a threshold higher than 5% may be more appropriate for assigning tumors to the high-grade category. Nonetheless, risk stratification incorporating tumor size and extent remains essential for prognostic evaluation.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.