Bladder cancer recurrence in papillary urothelial neoplasm of low malignant potential (PUNLMP) compared to G1 WHO 1999: a population-based study

Johannes Bobjer; Oskar Hagberg; Firas Aljabery; Truls Gårdmark; Staffan Jahnson; Tomas Jerlström; Amir Sherif; Athanasious Simoulis; Viveka Ströck; Christel Häggström; Lars Holmberg; Fredrik Liedberg

doi:10.1080/21681805.2021.1987980

Bladder cancer recurrence in papillary urothelial neoplasm of low malignant potential (PUNLMP) compared to G1 WHO 1999: a population-based study

Johannes Bobjer^*, Oskar Hagberg, Firas Aljabery, Truls Gårdmark, Staffan Jahnson, Tomas Jerlström, Amir Sherif, Athanasious Simoulis, Viveka Ströck, Christel Häggström, Lars Holmberg, Fredrik Liedberg

^*Corresponding author for this work

Comprehensive Cancer Centre

Research output: Contribution to journal › Article › peer-review

3 Citations (Scopus)

Abstract

Objective: Papillary urothelial neoplasm of low malignant potential (PUNLMP) and stage TaG1 non-muscle invasive bladder cancer (NMIBC) represent separate categories in current WHO 1999 grade definitions. Similarly, PUNLMP and Ta low-grade are separate entities in the WHO 2004/2016 grading system. However, this classification is currently questioned by reports showing a similar risk of recurrence and progression for both categories. Patients and methods: In this population-based study, risk estimates were evaluated in patients diagnosed with PUNLMP (n = 135) or stage TaG1 (n = 2176) NMIBC 2004–2008 with 5-year follow-up registration in the nation-wide Bladder Cancer Data Base Sweden (BladderBaSe). The risk of recurrence was assessed using multivariable Cox regression with adjustment for multiple confounders (age, gender, marital status, comorbidity, educational level, and health care region). Results: At five years, 28/135 (21%) patients with PUNLMP and 922/2176 (42%) with TaG1 had local recurrence. The corresponding progression rates were 0.7% (1/135) and 4.0% (86/2176), respectively. A higher relative risk of recurrence was detected in patients with TaG1 tumours compared to PUNLMP (Hazard Ratio 1.6, 95% CI 1.2–2.0) at 5-year follow-up, while progression events were too few to compare. Conclusions: The difference in risk of recurrence between primary stage TaG1 and PUNLMP stands in contrast to the recently adapted notion that treatment and follow-up strategies can be merged into one low-risk group of NMIBC.

Original language	English
Pages (from-to)	14-18
Number of pages	5
Journal	Scandinavian Journal of Urology
Volume	56
Issue number	1
DOIs	https://doi.org/10.1080/21681805.2021.1987980
Publication status	Published - 2022

Keywords

bladder cancer
grade 1
Papillary urothelial neoplasm of low malignant potential
PUNLMP
recurrence

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1080/21681805.2021.1987980

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Bobjer, J., Hagberg, O., Aljabery, F., Gårdmark, T., Jahnson, S., Jerlström, T., Sherif, A., Simoulis, A., Ströck, V., Häggström, C., Holmberg, L., & Liedberg, F. (2022). Bladder cancer recurrence in papillary urothelial neoplasm of low malignant potential (PUNLMP) compared to G1 WHO 1999: a population-based study. Scandinavian Journal of Urology, 56(1), 14-18. https://doi.org/10.1080/21681805.2021.1987980

@article{8c7035355a694520b2fce1926ca002b7,

title = "Bladder cancer recurrence in papillary urothelial neoplasm of low malignant potential (PUNLMP) compared to G1 WHO 1999: a population-based study",

abstract = "Objective: Papillary urothelial neoplasm of low malignant potential (PUNLMP) and stage TaG1 non-muscle invasive bladder cancer (NMIBC) represent separate categories in current WHO 1999 grade definitions. Similarly, PUNLMP and Ta low-grade are separate entities in the WHO 2004/2016 grading system. However, this classification is currently questioned by reports showing a similar risk of recurrence and progression for both categories. Patients and methods: In this population-based study, risk estimates were evaluated in patients diagnosed with PUNLMP (n = 135) or stage TaG1 (n = 2176) NMIBC 2004–2008 with 5-year follow-up registration in the nation-wide Bladder Cancer Data Base Sweden (BladderBaSe). The risk of recurrence was assessed using multivariable Cox regression with adjustment for multiple confounders (age, gender, marital status, comorbidity, educational level, and health care region). Results: At five years, 28/135 (21%) patients with PUNLMP and 922/2176 (42%) with TaG1 had local recurrence. The corresponding progression rates were 0.7% (1/135) and 4.0% (86/2176), respectively. A higher relative risk of recurrence was detected in patients with TaG1 tumours compared to PUNLMP (Hazard Ratio 1.6, 95% CI 1.2–2.0) at 5-year follow-up, while progression events were too few to compare. Conclusions: The difference in risk of recurrence between primary stage TaG1 and PUNLMP stands in contrast to the recently adapted notion that treatment and follow-up strategies can be merged into one low-risk group of NMIBC.",

keywords = "bladder cancer, grade 1, Papillary urothelial neoplasm of low malignant potential, PUNLMP, recurrence",

author = "Johannes Bobjer and Oskar Hagberg and Firas Aljabery and Truls G{\aa}rdmark and Staffan Jahnson and Tomas Jerlstr{\"o}m and Amir Sherif and Athanasious Simoulis and Viveka Str{\"o}ck and Christel H{\"a}ggstr{\"o}m and Lars Holmberg and Fredrik Liedberg",

note = "Funding Information: This work was supported by the Swedish Cancer Society (grant numbers CAN 2019/62 and CAN 2017/278), Lund Medical Faculty (ALF), Sk{\aa}ne University Hospital Research Funds, the Gyllenstierna Krapperup{\textquoteright}s Foundation, The Cancer Research Fund at Malm{\"o} General Hospital, Stiftelsen Sigurd och Elsa Goljes Minne, The Bergqvist Foundation, Sk{\aa}ne County Council{\textquoteright}s Research and Development Foundation (REGSKANE-622351), G{\"o}sta J{\"o}nsson Research Foundation, the Foundation of Urological Research (Ove and Carin Carlsson bladder cancer donation), and Hillevi Fries Research Foundation. The funding sources had no role in the study design, data analyses, interpretation of the results, or writing of the manuscript. Publisher Copyright: {\textcopyright} 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.",

year = "2022",

doi = "10.1080/21681805.2021.1987980",

language = "English",

volume = "56",

pages = "14--18",

journal = "Scandinavian Journal of Urology",

issn = "2168-1805",

publisher = "Informa Healthcare",

number = "1",

}

Bobjer, J, Hagberg, O, Aljabery, F, Gårdmark, T, Jahnson, S, Jerlström, T, Sherif, A, Simoulis, A, Ströck, V, Häggström, C, Holmberg, L & Liedberg, F 2022, 'Bladder cancer recurrence in papillary urothelial neoplasm of low malignant potential (PUNLMP) compared to G1 WHO 1999: a population-based study', Scandinavian Journal of Urology, vol. 56, no. 1, pp. 14-18. https://doi.org/10.1080/21681805.2021.1987980

TY - JOUR

T1 - Bladder cancer recurrence in papillary urothelial neoplasm of low malignant potential (PUNLMP) compared to G1 WHO 1999

T2 - a population-based study

AU - Bobjer, Johannes

AU - Hagberg, Oskar

AU - Aljabery, Firas

AU - Gårdmark, Truls

AU - Jahnson, Staffan

AU - Jerlström, Tomas

AU - Sherif, Amir

AU - Simoulis, Athanasious

AU - Ströck, Viveka

AU - Häggström, Christel

AU - Holmberg, Lars

AU - Liedberg, Fredrik

N1 - Funding Information: This work was supported by the Swedish Cancer Society (grant numbers CAN 2019/62 and CAN 2017/278), Lund Medical Faculty (ALF), Skåne University Hospital Research Funds, the Gyllenstierna Krapperup’s Foundation, The Cancer Research Fund at Malmö General Hospital, Stiftelsen Sigurd och Elsa Goljes Minne, The Bergqvist Foundation, Skåne County Council’s Research and Development Foundation (REGSKANE-622351), Gösta Jönsson Research Foundation, the Foundation of Urological Research (Ove and Carin Carlsson bladder cancer donation), and Hillevi Fries Research Foundation. The funding sources had no role in the study design, data analyses, interpretation of the results, or writing of the manuscript. Publisher Copyright: © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

PY - 2022

Y1 - 2022

N2 - Objective: Papillary urothelial neoplasm of low malignant potential (PUNLMP) and stage TaG1 non-muscle invasive bladder cancer (NMIBC) represent separate categories in current WHO 1999 grade definitions. Similarly, PUNLMP and Ta low-grade are separate entities in the WHO 2004/2016 grading system. However, this classification is currently questioned by reports showing a similar risk of recurrence and progression for both categories. Patients and methods: In this population-based study, risk estimates were evaluated in patients diagnosed with PUNLMP (n = 135) or stage TaG1 (n = 2176) NMIBC 2004–2008 with 5-year follow-up registration in the nation-wide Bladder Cancer Data Base Sweden (BladderBaSe). The risk of recurrence was assessed using multivariable Cox regression with adjustment for multiple confounders (age, gender, marital status, comorbidity, educational level, and health care region). Results: At five years, 28/135 (21%) patients with PUNLMP and 922/2176 (42%) with TaG1 had local recurrence. The corresponding progression rates were 0.7% (1/135) and 4.0% (86/2176), respectively. A higher relative risk of recurrence was detected in patients with TaG1 tumours compared to PUNLMP (Hazard Ratio 1.6, 95% CI 1.2–2.0) at 5-year follow-up, while progression events were too few to compare. Conclusions: The difference in risk of recurrence between primary stage TaG1 and PUNLMP stands in contrast to the recently adapted notion that treatment and follow-up strategies can be merged into one low-risk group of NMIBC.

AB - Objective: Papillary urothelial neoplasm of low malignant potential (PUNLMP) and stage TaG1 non-muscle invasive bladder cancer (NMIBC) represent separate categories in current WHO 1999 grade definitions. Similarly, PUNLMP and Ta low-grade are separate entities in the WHO 2004/2016 grading system. However, this classification is currently questioned by reports showing a similar risk of recurrence and progression for both categories. Patients and methods: In this population-based study, risk estimates were evaluated in patients diagnosed with PUNLMP (n = 135) or stage TaG1 (n = 2176) NMIBC 2004–2008 with 5-year follow-up registration in the nation-wide Bladder Cancer Data Base Sweden (BladderBaSe). The risk of recurrence was assessed using multivariable Cox regression with adjustment for multiple confounders (age, gender, marital status, comorbidity, educational level, and health care region). Results: At five years, 28/135 (21%) patients with PUNLMP and 922/2176 (42%) with TaG1 had local recurrence. The corresponding progression rates were 0.7% (1/135) and 4.0% (86/2176), respectively. A higher relative risk of recurrence was detected in patients with TaG1 tumours compared to PUNLMP (Hazard Ratio 1.6, 95% CI 1.2–2.0) at 5-year follow-up, while progression events were too few to compare. Conclusions: The difference in risk of recurrence between primary stage TaG1 and PUNLMP stands in contrast to the recently adapted notion that treatment and follow-up strategies can be merged into one low-risk group of NMIBC.

KW - bladder cancer

KW - grade 1

KW - Papillary urothelial neoplasm of low malignant potential

KW - PUNLMP

KW - recurrence

UR - http://www.scopus.com/inward/record.url?scp=85116680712&partnerID=8YFLogxK

U2 - 10.1080/21681805.2021.1987980

DO - 10.1080/21681805.2021.1987980

M3 - Article

C2 - 34623216

AN - SCOPUS:85116680712

SN - 2168-1805

VL - 56

SP - 14

EP - 18

JO - Scandinavian Journal of Urology

JF - Scandinavian Journal of Urology

IS - 1

ER -

Bladder cancer recurrence in papillary urothelial neoplasm of low malignant potential (PUNLMP) compared to G1 WHO 1999: a population-based study

Abstract

Keywords

UN SDGs

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