Prognosis of bladder tumor patients treated by TUR

One hundred and eleven cases of bladder tumors were treated with transurethral resection (TUR) and transurethral electrocoagulation as the initial treatment from 1974 and 1983. Eighty nine cases were male and 22 cases were female. The average age was 60.1 years old. Of the 111 patients, 57, 33, 2, 1 and 15 patients had a tumor of Ta, T1, T2, T3a and Tx respectively. The number of grades G0, G1, G2, G3, GX cases was 1, 38, 40, 17, 12, respectively. Other than these, 2 cases of squamous cell carcinoma and 1 of adenocarcinoma were included. The actual survival rates for 5 years in Ta and T1 were 84.4 and 88.9% respectively, and the relative survival rates were 99.5 and 109.1%. TUR was recommended for superficial bladder tumor because of good prognosis. The 5-year recurrence rates for single tumors with and without prophylactic bladder instillation were 21.4 and 27.5% respectively, and those for multiple bladder tumors were 58.6 and 51.8%. There was no significant difference between the group with and without bladder instillation.     

Treatment of 300 patients with bladder cancer]

From September 1973 to September 1989, 300 patients with bladder cancer were treated at the Department of Urology, Hyogo College of Medicine. They were 231 males and 69 females with an average age of 65.3 years old. The overall 5-year survival rate (Kaplan-Meier's method) was 64.7%. The 5-year survival rates were not different between male patients and female patients, or between patients with single tumor and patients with multiple tumors. Patients with vesical irritation symptoms had more unfavorable prognosis than patients with painless hematuria. Size and configuration of the tumors also affected the prognosis. Histological diagnosis was transitional cell carcinoma in 291 patients, squamous cell carcinoma in 7 patients, adenocarcinoma in one patient and undifferentiated carcinoma in one patient. In patients with transitional cell carcinoma, the 5-year survival rates according to histological grades were 93.5% for G1, 77.8% for G2 and 31.6% for G3. The 5-year survival rate according to clinical stage was 94.4% for Ta, 79.7% for T1, 66.7% for Tis, 46.1% for T2, 38.5% for T3 and 26.6% for T4. Transurethral resection of bladder tumor (TUR-b.t.) was performed in 208 patients as an initial operation and the 5-year survival rate in these patients was 78.6%. The 5-year survival rates for total cystectomy (52 patients), partial cystectomy (6 patients) and simple tumor resection (4 patients) were 51.9%, 25.0% and 37.5%, respectively. These findings suggest that superficial tumors (Ta, T1) can be controlled with TUR-b.t. but infiltrating tumors (T2, T3, T4) should be treated more vigorously with multidisciplinary approaches.(ABSTRACT TRUNCATED AT 250 WORDS)     

Treatment of 255 patients with bladder tumors

During about 10 years from November, 1977 to March, 1987, two hundreds and fifty-five patients with bladder tumors were treated at the Department of Urology, Hamamatsu University School of Medicine and the affiliated hospitals. There were 198 males and 57 females with the highest age incidence in the seventies. Histologically, 242, 11 and 2 tumors were of transitional cell, squamous cell and adenocarcinoma, respectively. Of the 242 transitional cell carcinomas, 7 were Tis; 43 Ta, 111 T1, 33 T2, 19 T3, 5 T4, 14 M+ (with metastatic lesion), and 10 TX. As to grading, 6 was G0; 66 G1, 100 G2, 64 G3, and 6 GX. Staging was correlated with grading. The 5-year survival rates (Kaplan-Meier's method) were 64% in patients with transitional cell carcinoma; 58% in those with squamous cell carcinoma. In patients with transitional cell carcinoma, the 5-year survival rates were 100% for G0, 73% for G1, 73% for G2 and 40% for G3. As to staging, the 5-year survival rates were 67%, 81%, 81%, 35%, 41%, 40% and 12% in patients with stage of Tis, Ta, T1, T2, T3, T4 and M+, respectively. As to the initial treatment, the 5-year survival rates after TUR (137 cases), partial cystectomy (4 cases) and total cystectomy (56 cases) were 81%, 36% and 61%, respectively. The rate of intravesical recurrence after TUR was evaluated with the cumulative non-recurrence rate calculated by Kaplan-Meier's method.(ABSTRACT TRUNCATED AT 250 WORDS)     

Clinical statistics of the bladder tumor--survival rates of 325 cases

To study the relationship between clinical features and prognosis of the bladder tumor, 325 patients who were treated in our hospital were analyzed. The overall 5-year and 10-year actual survival rates were 65% and 51%. There was no statistical significance in the actual survival rate between the single and multiple tumor group. Although, there was a significant difference in tumor size, tumor growing type and the mode of treatment. The ten-year survival rates for grades 1, 2 and 3 cases were 76%, 57% and 18%, respectively. There was a significant difference between grades 1 and 3 (p less than 0.001) and grades 2 and 3 (p less than 0.001). The ten-year survival rates for stages Ta, T1, T2, T3a, T3b and T2-4 M1 were 79%, 68%, 43%, 0%, 19% and 5%, respectively. There was a significant difference between the Ta, 1 and T2-4 group (p less than 0.001).     

Initial conservative treatment for grade 3 Ta-1 superficial bladder cancer

We retrospectively investigated the therapeutic outcomes of our series of 7 Ta and 62 T1 bladder cancers with grade 3 (G3) malignancy in 61 men and 8 women having a mean age of 66.2 years. Following transurethral resection of bladder tumor (TURBT), 35 and 6 patients received intravesical instillations of bacillus Calmette-Guerin (BCG) and anthracycline-derivants, respectively, whereas 15 received no adjuvant therapy. Five and 2 patients received systemic and local chemotherapy with irradiation, respectively, and six underwent radical cystectomy for invasive potential. The 5-year nonrecurrence, progression-free, and overall (cancer-specific) survival rates were 66, 82%, and 76 (88%), respectively, after a median follow-up of 52 months. The 5-year non-recurrence rates were 24% in non-adjuvant, 85% in BCG, 0% in anthracycline-derivants, 65% in systemic and local chemoradiation therapy, and 68% in cystectomy. The 5-year progression-free and overall (cancer-specific) survival rates of the patients treated with BCG instillation were 91% and 94 (100)%. There were no significant differences in the 5-year non-recurrence and progression-free rates between 12 patients with carcinoma in situ (CIS) and 23 patients without CIS. Complete TUR of all visible tumors and a reliable histopathological diagnosis of appropriate specimens bearing the muscle layer are mandatory for assessment of recurrence. G3 Ta-1 bladder cancers and CIS showed a high risk of recurrence, and required aggressive treatment. Since BCG therapy following TURBT significantly reduced the risk of recurrence and progression, adjuvant BCG therapy is considered to be the most promising initial conservative treatment for G3 Ta-1 bladder cancers.     

Recurrence, progression and survival in bladder cancer. A retrospective analysis of 232 patients with greater than or equal to 5-year follow-up

A retrospective study of 232 bladder tumours with minimum follow-up 5 years is presented. The carcinoma was superficial in 66%, muscle-invasive in 31% and could not be staged in 3%. Primary treatment was mainly transurethral resection for superficial tumour, but was cystectomy or radiotherapy in 22 of 29 T1 G3. Of the superficial tumours, 71% recurred. Progression to higher T stage occurred in 15% of Ta and 29% of T1 tumours, and half of these patients died of bladder cancer. The corrected 5-year survival rates in grades 1, 2A, 2B and 3-4 were 96, 84, 64 and 43%, and in stages Ta, T1, T2 and T3 they were 94, 69, 40 and 31%. All patients with T4 tumour died within 4 years. Among the 45 patients with 40 Gy irradiation + cystectomy, the corrected 5-year survival rate was 83% in superficial and 64% in muscle-invasive tumours, and among the 38 with radical radiotherapy the rates in T1-3 were 46, 36 and 13%. Transurethral resection was successful in most Ta cases. Most T1 tumours were, like T2-4, of higher grade than Ta. Prognosis was worse in T1 than in Ta. After progression to muscle-invasive disease, even during close follow-up the outlook was poor, as poor as for patients with primary muscle-invasive disease.     

Analysis of clinical characteristics, management and survival of patients with Ta T1 bladder tumours in Sweden between 1997 and 2001

OBJECTIVE: To analyse the management and outcome of patients with Ta T1 urinary bladder cancer in a population-based national database. MATERIAL AND METHODS: Between 1997 and 2001, 94% of all newly diagnosed cases of urinary bladder cancer were registered in the Swedish National Bladder Cancer Register. Data were analysed regarding gender, healthcare region, stage and grade for patients with Ta T1 tumours. The choice of initial treatment in different regions was reviewed. Survival was analysed by calculating relative survival. RESULTS: Out of 9859 registered patients, there were 4442 Ta tumours and 2139 T1 tumours. The median age at diagnosis was 72 and 73 years for patients with Ta and T1 tumours, respectively. Seventy-six percent of the patients were men. The choice of treatment varied between different healthcare regions. A significant trend towards an increased use of intravesical therapy was seen over time. Significantly fewer older than younger patients received such therapy. There was also a tendency towards more intensive therapy in men. The bladder cancer relative 5-year survival rate was 93% for Ta and 75% for T1 tumours. Survival was similar for men and women. CONCLUSIONS: Our analysis revealed a regional variation in the treatment of bladder cancer. A large group of patients, even those at high risk, were still undertreated. However, the recent publication of guidelines may have contributed to an increased use of intravesical treatment. Urologists tended to treat TaG3 and T1G3 tumours more aggressively than T1G2 tumours. Therapeutic aggressiveness decreased as the age of the patients increased. The survival rate of patients with bladder cancer in Sweden seems to remain at the levels previously reported for the 1980s.     

Transurethral resection and intra-arterial chemotherapy for muscle-invasive bladder cancer

Thirty-three patients with muscle-infiltrating T2–T3a bladder carcinoma were treated by TUR through the full thickness of the bladder wall and extended into the perivesical fat. The solitary tumours were not more than 4 cm in diameter. Histology proved in every case tumour stages of pT2 (17 patients) or pT3a (16 patients), G2 or G3 transitional cell carcinoma and negative mucosal biopsies. After TUR the patients received 1 or 2 cycles of chemotherapy: 60 mg of doxorubicin, 50 mg of cisplatin, 1 g of 5-fluorouracil administered into the ipsilateral hypogastric artery. There was no perioperative mortality but one patient died of complications related to chemotherapy. During the first year of follow-up relapses of muscle-invasive cancer were observed in 3 patients (10%), two were subjected to cystectomy and one to repeated TUR. With a median follow-up of 34 months 27 patients are alive and have functional bladder. The actual 3-year and 5-year survival rates were 17/21 (81%) and 6/9 (67%), respectively. The results of this study suggest that in strictly selected patients extended TUR and intra-arterial chemotherapy may be a bladder-preserving treatment modality for muscle-invasive bladder cancer. Regular (three monthly cystoscopy, cytology, biopsy, CT) investigations and follow-up are necessary to detect recurrences.     

Transurethral resection of 1250 bladder tumours

A total of 1250 bladder tumours were subjected to transurethral resection (891 curative, 107 palliative operations, 252 TUR biopsies). Complication rate was 9.9%, mortality rate 0.8%. In patients with primary tumours the 1-year recurrence rate after TUR was 23.8%, the 3-year rate was 36.6%, with an increase in proportion to stage. The 5-year survival rate was 66.5%. Within five years 9% of the patients died from tumour generalization, also with a rising tendency in proportion to stage. TUR as a curative method is suitable mainly for the removal of Ta and T1, under circumstances also of T2 G1-G2 tumours.     

初发T1G3膀胱尿路上皮癌行膀胱全切还是保留膀胱手术?

目的 比较根治性膀胱全切与保留膀胱手术治疗初发T1G3膀胱尿路上皮癌的临床效果.方法 初发T1G3膀胱尿路上皮癌患者113例.男91例,女22例.年龄27～88岁,平均64岁.初次治疗保留膀胱患者81例,行根治性膀胱全切患者32例.采用Kaplan-Meier生存分析及log-rank检验比较2组患者5年总生存率及肿瘤特异性生存率.结果 初次治疗保留膀胱患者81例中行经尿道肿瘤电切术74例、膀胱部分切除7例,术后随访6～140个月,平均64个月,术后5年总生存率为64.2%(52/81),肿瘤特异性生存率为77.8%(63/81).根治性膀胱全切治疗32例,术后随访4～141个月,平均62个月.术后5年总生存率为59.4%(19/32),肿瘤特异性生存率为75.0%(24/32).2组术后5年总生存率及肿瘤特异性生存率比较差异均无统计学意义(P>0.05).结论 保留膀胱手术或根治性膀胱全切治疗初发T1G3膀胱癌,5年总生存率和肿瘤特异性生存率差异无统计学意义.膀胱全切治疗初发T1G3膀胱肿瘤至少有50%的病例有过度治疗的可能.     

欧洲癌症研究与治疗组织风险评分表在非肌层浸润性膀胱尿路上皮癌中的临床应用初探

目的 评价欧洲癌症研究与治疗组织风险评分表(European Organization for Research and Treatment of Cancer risk tables,EORTC风险评分表)用于非肌层浸润性膀胱尿路上皮癌患者预后评估的可行性.方法 回顾性分析2003年1月至2009年2月收治的185例非肌层浸润性膀胱尿路上皮癌患者临床资料,其中Ta128例、T1 57例;G1 87例、G253例、G345例;肿瘤数目为单发、2～7个、≥8个者分别120、36、29例;肿瘤直径＜3 cm者131例、≥3 cm者54例;伴发原位癌者6例.185例均行经尿道膀胱肿瘤电切术,术后均行常规膀胱灌注化疗.采用电话随访方式,随访6～77个月,平均36个月.应用EORTC风险评分表进行预后风险评分,计算各评分组患者的1年复发率和进展率,并与EORTC评分表的预计值进行比较.结果 185例中1年内复发48例(25.9%),1年内出现肿瘤进展者7例(3.8%).根据患者实际情况计算,0、1～4、5～9、10～17分4组患者1年实际复发率分别为10.4%(5/48)、21.5%(14/65)、35.2%(19/54)、55.6%(10/18);0、2～6、7～13、14～23分患者1年实际进展率分别为0(0/43)、1.5%(1/67)、6.7%(4/60)、13.3%(2/15).经x2检验,结果与评分表的预计值差异无统计学意义(P＞0.05);而低危、中危、高危3组患者1年复发率及进展率差异有统计学意义(P＜0.05).结论 EORTC风险评分表可用于非肌层浸润性膀胱尿路上皮癌术后复发和进展风险的短期预测,对长期预测的应用及广泛人群的适用性尚待进一步验证.

Abstract：

Objective To evaluate the feasibility of European Organization for Research and Treatment of Cancer (EORTC) risk tables in non-muscle invasive bladder cancer in Chinese patients.Methods A retrospective analysis was performed on the data from 185 patients with non-muscle invaaive urothelial bladder cancer from January 2003 to February 2009. Among the 185 patients, 128 patients were stage Ta compared with 57 patients who were stage T1. There were 87, 53 and 45 patients with grade G1, G2 and G3 respectively. Transurethral resection of the bladder tumor was performed on all the patients and all the patients received routine post-operative intravesical instillation. A telephone interview follow-up was conducted on all the patients, and the average follow-up period was 36 months. EORTC risk tables were used to calculate risk scores for recurrence and progression for each patient. The recurrence and progression rates of different risk groups were recorded and compared with the estimated rates by EORTC risk table. Statistical analysis was used for comparison. ResultsTotal 1-year recurrence rate and progression rate for these patients were 25.9% and 3.8% respectively. According to calculated values of the patients, the 1-year recurrence rates of Group 0, Group 1-4, Group 5-9, Group 10-17 were 10.4%(5/48), 21. 5%(14/65), 35. 2% (19/54), 55.6%(10/18), respectively. The 1-year progression rates of Group 0, Group 2-6, Group 7-13, Group 14-23 were 0% (0/43), 1.5% (1/67), 6. 7% (4/60), 13. 3% (2/15). There was no significant difference between the real rates and estimated rates of the EORTC risk tables (P＞0. 05). However,the 1-year recurrence and progression rates between the low risk group, the medium risk group and the high risk group showed significant differences respectively (P ＜ 0. 05 ). Conclusions The EORTC risk tables are feasible to evaluate the recurrence and progression risk of non-muscle invasive bladder cancer in the present cohort. Nevertheless, the long term value and feasibility need more research to confirm.     

Outcome of very large superficial bladder tumours: a 10-year experience

OBJECTIVES: To determine the biological behaviour of very large superficial bladder tumours (pTa, pT1) and evaluate the impact of the initial tumour weight on long-term prognosis. MATERIAL AND METHODS: Of 1569 patients who presented with bladder tumours over a 10-year period, 1070 of the tumours were superficial. Fifty-nine patients had very large tumours (resected weight >or= 15 g). Case notes were analysed to determine recurrence, progression and survival. Median follow-up was 60 months (range 1-156 months). Histological slides were reviewed for all tumours initially reported as pT1 to determine the presence of uninvolved muscle. Statistical analysis was performed using the Kaplan-Meier method to calculate progression and survival estimates. RESULTS: The overall progression and recurrence rates for very large superficial bladder tumours were 18% and 68%, respectively. The progression rates for Ta, T1, G1, G2 and G3 tumours were 4%, 28%, 0%, 20% and 50%, respectively, with highest progression rates being seen for pT1G2 and pT1G3 tumours. The progression rate was significantly influenced by initial stage (p=0.01) and grade (p=0.03). Tumour weight did not affect either recurrence, progression or cause-specific survival. There were no differences in progression and survival rates in patients with tumour weights of 15-30 and >30 g (p=0.80 and 0.07, respectively). The review of histology slides of T1 tumours showed that 7/10 cases (70%) with progression had no muscle or an inadequate amount of muscle for definitive staging. Upper urinary tract tumours were seen in only two patients (3.4%). CONCLUSIONS: Large size is not an adverse prognostic factor for patients with a superficial bladder tumour. However, these cases are difficult to stage. In view of the high rates of progression and disease-specific mortality, we recommend that very large pT1G2 bladder tumours should be considered as high-risk tumours and targeted for aggressive treatment, including early re-resection, to rule out any occult invasive disease.     

Clinical outcome of tumor recurrence for Ta, T1 non-muscle invasive bladder cancer from the data on registered bladder cancer patients in Japan: 1999–2001 report from the Japanese Urological Association

Objective:   To characterize the clinical outcome in a large contemporary series of Japanese patients with newly diagnosed Ta, T1 non-muscle invasive bladder cancer who underwent transurethral bladder tumor resection with or without intravesical chemotherapy or Bacillus Calmette-Guérin (BCG) therapy.
Methods:   We developed a database incorporating newly diagnosed non-muscle invasive bladder cancer data and outcomes from a Japanese bladder cancer registry between 1999 and 2001 and identified a study population of 3237 consecutive patients who had complete data based on pathological features. Median patient age was 69.9 years.
Results:   The 1-year, 3-year, and 5-year overall recurrence-free survival rates were 77.0%, 61.3%, and 52.8%, respectively. In multivariate analyses, the multiplicity of bladder tumors, tumor size greater than 3 cm, pathological stage T1, tumor grade G3, and the absence of adjuvant intravesical instillation were independent risk factors for tumor recurrence. Overall, 1710 patients (52.8%) received intravesical instillation; chemotherapy in 1314 (76.8%) and BCG treatment in 396 (23.2%). In patients treated with intravesical chemotherapy in which an anthracycline chemo-agent was used in 90.5% of the cases, multivariate analyses demonstrated that male gender, multiple bladder tumors, a tumor size greater than 3 cm, and pathological stage T1 were associated with tumor recurrence.
Conclusions:   The accumulation and analysis of data from the Japanese National Bladder Cancer Registry made it possible to determine the clinical characteristics, management trends, and survival rates for the period studied. Further study with a dataset created from longer follow-up data would be warranted to analyze tumor progression and disease survival.     

A population-based study of 538 patients with newly detected urinary bladder neoplasms followed during 5 years

OBJECTIVE: To describe in detail the diagnosis and clinical course of an unselected population-based cohort of patients with newly diagnosed bladder neoplasms. MATERIAL AND METHODS: A total of 538 patients registered in the Stockholm region with newly diagnosed primary bladder neoplasms (transitional cell carcinomas) in 1995 and 1996 were followed for at least 5 years. All hospitals and urology units in the region participated in the study. Treatment and follow-up were performed according to a standard-of-care programme. Routine pathological reports were used. Original case records were scrutinized on location in 2001. In addition, a tumour bank of freshly frozen tumour tissue was established. RESULTS: The calculated 5-year cancer-specific survival rate for the 538 patients in the cohort was 78%. No patient (0/29) with TaG1 tumours showed progression or died of bladder cancer. Only 2/187 patients (1%) with stage Ta and grade 2A or 2B tumours died of bladder cancer. In contrast, after 5 years of follow-up, patients with TaG3 and T1G2B tumours had disease-specific death rates of 20% and 27%, respectively. The result of the first cystoscopy examination after the initial resection of non-invasive tumours was of prognostic value. Recurrent disease was present in 62% (248/402) of all patients with Ta and T1 tumours at diagnosis and patients with T1 tumours had recurrences earlier than those with Ta tumours. Moreover, 32% (35/110) of the patients who presented with T1 tumours at diagnosis progressed to muscle-invasive disease during the follow-up period. The overall prognosis for patients presenting with muscle-invasive tumours (T2+) was dismal, with 69% (80/116) of the patients dying of the disease. CONCLUSIONS: We analysed a population-based cohort of patients with urinary bladder neoplasms in order to establish a clearly defined and unselected clinical series, with the main aims of comparing and evaluating the clinical utility of new molecular biology techniques. In the present series, TaG1 tumours behaved benignly. The disease-specific mortality rate was low for initial TaG2 tumours, intermediate for initial TaG3 and T1 tumours and high for initial T2+ tumours.     

T1G3膀胱尿路上皮癌复发与进展影响因素分析

目的探讨影响T1G3膀胱尿路上皮癌复发与进展的因素,为临床治疗提供循证医学依据。方法回顾性分析1997年至2009年我科治疗的62例行经尿道膀胱肿瘤电切术(TURBT)+膀胱灌注治疗的T1G3膀胱尿路上皮癌患者,对这些患者进行随访并对生存预后进行分析。生存函数运用Kaplan-Meier法,单因素和多因素分析运用Cox回归,并采用Log-rank法行显著性检验。结果中位随访期40个月(6～140个月),41例(66.0%)复发,2、5年无复发生存率分别为43.4%、35.1%。14例(23.0%)出现进展,2、5年无进展生存率分别为86.4%、83.5%。将与复发相关的危险因素纳入Cox回归多因素生存分析后提示肿瘤复发的危险因素为肿瘤数目(RR=2.250)、肿瘤大小(RR=1.039)、既往复发情况(RR=2.162),P均<0.05;与进展相关的危险因素纳入Cox回归多因素生存分析,提示肿瘤进展的危险因素为肿瘤数目(RR=3.695)。结论肿瘤数目是T1G3膀胱尿路上皮癌复发最大的影响因素,其次为既往复发情况和肿瘤大小,肿瘤数目是肿瘤进展的相关因素;T1G3膀胱尿路上皮癌需结合肿瘤数目、肿瘤大小、既往复发情况综合考虑治疗方案。     

Neural network analysis of clinicopathological and molecular markers in bladder cancer

PURPOSE: To evaluate retrospectively the ability of an artificial neural network (ANN) to predict bladder cancer recurrence within 6 months of diagnosis and stage progression in patients with Ta/T1 bladder cancer, and 12-month cancer-specific survival in patients with T2-T4 bladder cancer. MATERIALS AND METHODS: Data were analyzed using a NeuralWorks Professional II/Plus software package. The input neural data consisted of clinicopathological and molecular characteristics. Distinct patient groups were used for the prediction of stage progression and tumor recurrence in Ta/T1 bladder cancers, and 12-month cancer-specific survival for patients with T2-T4 tumors. ANN predictions were compared with those of four consultant urologists. RESULTS: The accuracy of the neural network in predicting stage progression and recurrence within 6 months for Ta/T1 tumors and 12-month cancer-specific survival for T2-T4 cancers was 80%, 75% and 82% respectively; with corresponding figures for clinicians being 74%, 79% and 65%. On restricting the validation subset to patients with T1G3 tumors in relation to stage progression, the sensitivity of the ANN analysis increased to 100% with a specificity of 78% and an overall accuracy of 82%. The performance of the ANN in predicting stage progression in T1G3 tumors was significantly higher than that of clinicians (p = 0.25 for the ANN and p = 0.008 for clinicians, McNemar test). CONCLUSIONS: Data analysis using an ANN has been shown to be a useful adjunct in predicting outcomes in patients with bladder cancer and out-performs clinicians' predictions of stage progression in the high risk group of patients with T1G3 disease.     

Clinical significance of the stereological estimation of mean nuclear volume in human bladder carcinoma--relation to tumor grade, stage and prognosis]

Quantitative analysis of the malignant potential in cancer cells is a method currently under discussion. Recently the stereological estimation of cancer cells has been utilized in making an objective and quantitative pathological diagnosis. In this study, we estimated the mean nuclear volume (MNV) of untreated bladder carcinomas in 128 patients by stereological methods and attempted to quantitatively analyze the malignant potential of the carcinoma. The MNV was significantly enlarged as the tumor advanced in grade and stage. MNV was largest in grade 3 tumors (340.2 +/- 100.1 microns3) followed by grade 2 tumours (206.2 +/- 90.6 microns3) (P less than 0.01), and grade 1 tumors (130.6 +/- 46.7 microns3) (P less than 0.01). MNV was larger in pT1 tumors (278.2 +/- 126.9 microns3) than in pTa tumors (156.9 +/- 60.5 microns3) (P less than 0.01). MNV was also larger in invasive tumors (T2, T3 and T4: 318.2 +/- 104.0 microns3) than in superficial tumors (Ta and T1: 203.5 +/- 109.2 microns3) (P less than 0.01). Patients were then divided into two subgroups, one with large nuclei (MNV greater than or equal to 197.3 microns3), and the other with small nuclei (MNV less than 197.3 microns3). Survival and disease-free rates in patients with small nuclei (5-year survival rate: 92.9%, 5-year disease-free rate: 24.4%) were significantly better than in patients with large nuclei (5-year survival rate: 58.0%, 5-year disease-free rate: 12.5%). For patients with grade 2 tumors, those with small nuclei had a good survival rate (5-year survival rate: 95.5%), similar to that of patients with grade 1 tumors (5-year survival rate: 95.0%).(ABSTRACT TRUNCATED AT 250 WORDS)     

TUR and adjuvant intravesical chemotherapy in T1G3 bladder tumors: recurrence, progression and survival in 137 selected patients followed up to 20 years

OBJECTIVES: To evaluate a highly selected population of patients affected by T1G3 bladder transitional cell carcinoma (TCCB) treated by transurethral resection (TUR) and adjuvant intravesical chemotherapy. MATERIALS AND METHODS: Between January 1976 and April 1999, 137 patients with T1G3 TCCB were treated by TUR plus intravesical chemotherapy. Particularly, a sequential combination of mitomycin C (MMC) and epirubicin (EPI) was adopted in 91 patients (66.4%). The main exclusion criteria were concomitant or previous Tis, previous T1G3 TCCB, tumor size greater than 3 centimeters and number of tumors more than 3. TUR was repeated if a superficial tumor recurred. Patients went off study if Tis, recurrent T1G3 or invasive tumor were detected during treatment or thereafter. Adjuvant therapy, recurrence and progression were considered in multivariate analysis regarding recurrence, progression and survival respectively. RESULTS: Observation period was up to 240 months with a minimum of 2 years in 112 patients (82%). Seventy patients (51%) recurred. The recurring tumor was again a T1G3 in 22 (16%) patients. Thirteen patients (9.5%) progressed. The 5-year progression-free survival rate was 90%. Median progression-free survival was 149 months. Twenty-two patients (16%) died, 9 (6.6%) of whom due to bladder cancer. Median overall survival was 155 months. The 3- and 5-year disease-free overall survival rates were 89% and 80% respectively. Ten cystectomies (7.3%) were performed. In conclusion, 123 patients (90%) maintained their intact bladder with a mean disease-free overall survival of 104 months. The sequential combination of MMC and EPI adjuvant therapy resulted more effective to be than single drug chemotherapy on recurrence rate (p=0.0021) but had no impact upon progression (p=0.127) and specific survival (p=0.163). Progression (p<0.001) after conservative treatment was the main prognostic factor for survival. CONCLUSION: A conservative approach is an appropriate therapeutic option for the initial management of selected T1G3 bladder tumors.     

Total cystectomy for urinary bladder cancer: clinicopathological study of 95 cases

Total cystectomy was performed on 95 patients with primary urinary bladder cancer between 1973 and 1983. Histopathological and prognostic studies were reviewed according to the general rules for clinical and pathological studies on bladder cancer. The cancer histological type were transitional cell carcinoma in 87 cases, squamous cell carcinoma in 5 cases, adenocarcinoma in 2 cases, and undifferentiated carcinoma in 1 case. The overall 5-year actuarial survival rate was 36.0%. As for the growth pattern of the bladder cancer, the 5-year survival rates for the patients with papillary non-invasive type (PNT), papillary invasive type (PIT), and non-papillary invasive type (NIT) were 100%, 25.8% and 34.8% respectively. As for the stage, the 5-year survival rates for the patients with pTa, pT1, pT2, pT3a, pT3b, and pT4 were 81.8%, 64.7%, 40.1%, 30.5%, 22.6% and 6.7% respectively. Of 87 patients with transitional cell carcinoma, the 5-year survival rates for the patients with grade 1, grade 2 and grade 3 were 100%, 43.0% and 32.1% respectively. Intramural lymphatic invasion and vascular invasion and intramural histopathological mode of spread were significant indicators of prognosis.     

T1G3 bladder cancer--indications for early cystectomy

OBJECTIVES: To review our experience with early radical cystectomy in patients with T1G3 Transitional Cell Carcinoma of bladder (TCC). PATIENTS AND METHODS: Thirty patients, who underwent early radical cystectomy over a 10-year period for clinical stage T1G3 TCC bladder, were studied. Of these 21 (70%) had radical cystectomy without treatment with intravesical chemo/immunotherapy. The number of tumours, presence or absence of Carcinoma In-Situ (CIS) and the pathological stage of the cystectomy specimen were recorded in each patient. Disease specific survival was determined in the subgroups using Kaplan-Meier estimates. RESULTS: Seventeen patients underwent radical surgery for a single tumour without concomitant CIS (Group A). The other 13 had multiple tumours with or without concomitant CIS or a single tumour with CIS (Group B). The disease was upstaged after cystectomy in 1 (6%) patient in Group A compared to 7 (55%) in Group B, (p = 0.009). Nine (53%) had pT0 disease in Group A compared to 0% in Group B, (p = 0.0017). The 5-year cancer specific survival rates were 92% in Group A and 82% in Group B. CONCLUSIONS: In patients with multiple T1G3 tumours with or without associated CIS, or in those with single T1G3 tumour with associated CIS the incidence of the disease being already muscle invasive at the time of clinical diagnosis is 55%. Early radical cystectomy should be advocated in this group. Conversely, for a single T1G3 tumour without associated CIS, conservative bladder preserving strategy with immuno-chemotherapy and close surveillance is justified.