Clinical value of the WHO classification system of thymoma

Since the World Health Organization (WHO) histologic classification system for thymoma was introduced in 1999, several centers have published results using this system. This review of the published experience with the WHO system examines whether the classification is reproducible, whether the WHO system defines clinically distinct patient groups, assesses the independent prognostic value of the WHO type by multivariate analysis, and discusses the impact of the WHO system on clinical management decisions.     

非浸润性膀胱尿路上皮癌不同病理分级方法的临床应用价值比较

目的 比较非浸润性膀胱尿路上皮癌WHO 2004年和1973年病理分级方法的临床应用价值.方法 采用WHO 2004和1973 2种病理分级方法对160例非浸润性膀胱尿路上皮癌患者进行病理分级,随访患者复发和进展情况,比较分析2种分级系统临床应用差异. 结果 160例患者按1973分级方法:乳头状瘤5例,尿路上皮癌G_1 52例、G_2 83例、G_3 20例;按2004分级法:乳头状瘤7例,低度恶性潜能尿路上皮乳头状瘤(PUNLMP)31例、低分级尿路上皮乳头状癌(LGPUC)99例、高分级尿路上皮乳头状癌(HGPUC)23例.1973分级法各级别间复发与进展情况差异均无统计学意义(P>0.05);2004分级法各级别间复发差异无统计学意义(P>0.05),进展情况差异有统计学意义(P<0.05),其中PUNLMP与HGPUC差异有统计学意义(P<0.01).2004分级法HGPUC级别进展率(30.4%)明显高于1973分级法G_3级别进展率(15.0%). 结论 WHO 2004分级法中HGPUC级别衍含更多的高度恶性尿路上皮细胞癌,较1973分级法G_3级别更容易发生进展,临床上对HGPUC级别患者应采用更严密的治疗和随访措施.     

2004年和1973年世界卫生组织肿瘤分级预测局限浸润性膀胱癌复发价值的比较

目的 比较2004年和1973年WHO肿瘤分级预测局限浸润性(T分期≤pT2b)膀胱尿路上皮癌行根治性膀胱切除术后肿瘤复发概率的价值.方法 回顾分析2000年2月至2011年8月具有完善随访结果的173例局限浸润性膀胱尿路上皮癌患者的临床及随访资料.采用Kaplan-Meier法和Log-rank检验评估无复发生存率(RFS);Cox比例风险模型进行单因素及多因素分析评估膀胱癌各传统预后因素(肿瘤分期、分级,淋巴结状况,淋巴血管肿瘤浸润情况,术前肾积水,是否纯尿路上皮癌)对RFS的影响.结果 患者5年RFS为84.7％.Cox分析显示,采用2004年WHO分级时,淋巴结阳性(RR =4.573,95％ CI:1.469～14.237)、肿瘤分级(RR=9.993,95％ CI:1.325 ～ 75.390)、术前肾积水(RR=3.207,95％ CI:1.209 ～8.508)是RFS的独立预测因素;采用1973年WHO分级时,淋巴结阳性(RR=9.484,95％ CI:3.450 ～26.074)和淋巴血管肿瘤浸润(RR=3.009,95％ CI:1.062 ～8.526)是RFS的独立预测因素.结论 2004年WHO分级作为RFS的独立预测因素,较1973年WHO分级更适用于T2b期以下局限浸润性膀胱癌,但仍需要进一步的前瞻性研究以证实其预后预测作用.     

The WHO surgical checklist

Following the overwhelming evidence of adverse events in hospital practice, the World Health Organization (WHO)'s World Alliance for Patient Safety has launched the 'Safe Surgery Saves Lives' campaign, which has developed a surgical safety checklist aimed to improve patient safety. The implementation of this checklist has met with mixed reactions in different institutions. Many countries have still not adopted its use. In this article, a brief review is presented regarding the role of the WHO checklist, barriers to its implementation and strategies for successful adoption.     

WHO classification in thymoma

WHO classification of thymic epithelial tumors have been shown to reflect their oncological behaviors, and type A, AB and B1 tumors have better prognosis than type B2 and B3 tumors, suggesting the significance of this classification in the clinical practice of thymomas. Type B tumors are more invasive than type A and AB tumors. Type B1 and B2 tumors are frequently associated with myasthenia gravis while type A and AB tumors are not. The findings of computed tomography (CT) imaging revealed that type A and AB tumors tend to be round and have the smooth surface while type B1, B2 and B3 tumors are often flat and have irregular surface. Type AB, B1 and B2 tumors possess a significant number of CD4+CD8+ double positive T cells in the tumor. These observations are supposed to be useful for preoperative evaluation of WHO classification of thymomas, and to help the clinicians decide application of preoperative therapy and the method of surgical resection including endoscopic surgery.     

Grading of intracranial tumors following the WHO classification

The grading scheme contained in the WHO classification Histological Typing of CNS Tumors has been introduced after long and controversial discussions. Of the three major systems for grading intracranial tumors which were at hand, Zülch's is closest to the WHO system. The criteria for, and general remarks about, the WHO system for the evaluation of malignancy grades are delineated. Their almost complete concordance with Zülch's horizontal scheme ist emphasized, although some minor differences are mentioned. It is the author's belief, which may, however not be theoretically fully justified, that this system has been applied successfully since the publication of WHO classification. Opposition to WHO grading mostly reflects general pessimism about the possibility of gaining information concerning proliferation from morphology. However, the analysis of therapeutic trials in the last decades has shown that histological grade is of great predictive value. This correlation can be improved by the broad and exact application of the system.     

Comparison of WHO 1973, WHO/ISUP 1998, WHO 1999 grade and combined scoring systems in evaluation of bladder carcinoma

OBJECTIVES: To compare WHO 1973, WHO/ISUP 1998 and WHO 1999 histologic grading systems, and also to evaluate the primary (most common) and secondary (second most common) patterns of cancer growth according to these three grading systems. MATERIAL AND METHODS: The study consisted of 87 bladder transurethral resections that were classified as grade 1, 2 and 3, and papillary urothelial neoplasm of low malignant potential (PUNLMP), low grade (LG) and high grade (HG) carcinoma considering WHO 1973 and WHO/ISUP, respectively. The WHO 1999 system was subdivided high grade into grades 2 and 3 (HG-2 and HG-3). For combined scoring, primary (most common) and secondary (second most common) grades according to extension were recorded for three grading systems. The number was repeated when only grade was seen in all extension of the tissue examined. A final combined score was obtained which ranged from 2 to 6 for the WHO 1973 and WHO/ISUP 1998 systems and from 2 to 8 for the WHO 1999 schema. The TNM system was used for the pathologic staging. RESULTS: When considering the pathological stage, there were statistical differences between the WHO 1973 grades (p=0.011 and p=0.000), and LG and HG carcinomas of WHO/ISUP 1998 (p=0.000) and also the WHO 1999 grades (p=0.010 and p=0.003), except PUNLMP. Regarding the combined scoring, significant differences were found between score 4 (2+2) and 5 (2+3) of WHO 1973 (p=0.014) and score 5 (LG+HG) and 6 (HG+HG) of WHO/ISUP 1998 (p=0.011). There was also a significant difference between scores 4 and 6, and 6 and 8 of the WHO 1999 combined scoring system (p=0.019 and p=0.019). WHO 1973, WHO/ISUP 1998 and WHO 1999 systems were positively correlated with the pathological stage (r(s)=0.30, r(s)=0.52 and r(s)=0.50, respectively), whereas there was weak association between the combined scoring systems and stage (r(s)=0.20, r(s)=0.18 and r(s)=0.19). Comparing these grading systems, the grade 2 of WHO 1973 was subdivided into LG and HG in WHO/ISUP 1998 and also LG-1and HG-2 in WHO 1999 systems. The group of HG carcinoma in WHO/ISUP 1998 which was subdivided into HG-2 and HG-3 in the WHO 1999 system was different statistically in relation to the stage. CONCLUSIONS: Our results revealed that the WHO 1999 system may be more useful to evaluate the bladder carcinoma histopathologically in comparison to the WHO 1973 and WHO/ISUP 1998 systems.     

Commentary on WHO GATE Initiative

Assistive technology is essential to people with spinal cord injuries (SCI) for living and participating in their communities. However, many people with SCI do not have access to adequate assistive technology and qualified services. The World Health Organization (WHO) is addressing this need through the Global Cooperation on Assistive Technology (GATE). The GATE initiative is focused on improving access to high-quality affordable AT world-wide. GATE working to meet the AT sector needs in response to the call by WHO to increase access to essential, high-quality, safe, effective and affordable medical devices, which is one of the six WHO leadership priorities.