Need for intravenous urography in patients with primary transitional carcinoma of the bladder?

OBJECTIVE: To assess the need for and the efficacy of intravenous urography in the detection of a synchronous upper tract urothelial tumor (UTUT) in patients with primary bladder tumor. MATERIALS: Between 1986 and 1996, 793 patients were diagnosed as having primary tumor of the bladder with pathological confirmation of transitional cell carcinoma. All patients underwent intravenous urography prior to transurethral resection. The mean age of the patients was 66.4 years, and 87.7% of them were male. Of these patients, 72% had superficial tumors, while the remaining 28% had infiltrative tumors. Histological classification of the tumors was: grade I, 10%; grade II, 45%, and grade III, 45%. A chi(2) test was used for statistical analysis. RESULTS: The incidence of upper tract urothelial tumors was 1.1% (9 patients), although intravenous urography only diagnosed 6 cases (0.7%). No differences were seen between patients with or without UTUT with regard to histological grade (p = 0.7), multiple bladder tumors (p = 0.7) and tumor infiltration (p = 0.9). In 5.8% of the patients an unsuspected associated pathology was detected which required treatment in 1.4% of the cases. CONCLUSIONS: Due to the low incidence of UTUT (1.1%) in our series and to the fact that intravenous urography was effective in diagnosing synchronous UTUT in only 66.6% of cases, we do not consider that this procedure should be routinely performed in the diagnostic workup of patients with primary transitional cell tumor of the bladder.     

Routine excretory urography in follow-up of superficial transitional cell carcinoma of bladder

To determine cost-effective guidelines for the follow-up of patients with superficial transitional cell carcinoma of the bladder (STCCAB), we reviewed clinical histories, pathology reports, and intravenous pyelography results in 84 patients with Stage Ta or T1 disease. In 4 patients (4.8%) subsequent upper tract tumors developed with an average interval from initial presentation to the development of upper tract disease of 5.4 years. Three of these patients were treated successfully. We recommend upper tract surveillance in this group of patients with intravenous pyelography at diagnosis and every twenty-four months thereafter, or selection of those patients who are at high risk for development of upper tract disease (i.e., ureteral-vesical reflux) with voiding cystourethrography one month following each resection of tumors near a ureteral orifice. Refluxing patients should then either undergo surgical repair of their reflux or yearly pyelography.     

肾盂输尿管移行上皮癌术后再发膀胱癌多因素分析

目的防止肾盂输尿管癌术后再发膀胱癌。方法采用回顾性研究对获随访８５例进行总结。结果术后膀胱癌再发率３８％（３２／８５）。吸烟指数＞５００者为５４％（１８／３３），高于不吸烟或吸烟指数＜５００者的２７％（１４／５２），Ｐ＜０．０１。未切除患侧输尿管口周围膀胱壁的再发率为４５％（１０／２２），高于肾输尿管膀胱部分切除术的２０％（９／４５），Ｐ＜０．０５。Ⅱ～Ⅲ级，Ｔ１～Ｔ２，ＣｅｒｂＢ２阳性表达者再发率高，术后灌注化疗２年后再发率５％（２／３９），低于未灌注者的２２％（１０／４６），Ｐ＜０．０５。结论吸烟是术后再发危险因素，切除输尿管口周围部分膀胱壁是防止再发的关键，术后灌注化疗防止远期再发效果好。     

Cytogenetic analysis of transitional cell carcinoma of the bladder. Clinical implications

Cytogenetic analysis of resected bladder tumors was performed in 30 patients. None of these patients had previous irradiation or chemotherapy. Direct chromosome preparations were made. Of the 30 preparations, 20 had chromosome abnormalities. We have observed a good correlation between the chromosome abnormalities and the stage/grade of the tumors. Patients were followed from 3 to 23 months. During this period, 61% of the patients with noninvasive or submucosal invasive bladder tumors and chromosome abnormalities have had recurrences. The existence of a good correlation between chromosomal abnormalities and the capacity of the neoplasm to recur was confirmed.     

Cellular fibronectin in patients with transitional cell carcinoma of the bladder

Various tumor markers for transitional cell carcinoma (TCC) of the bladder have been described, but none of them are used in clinical routine. Fibronectin, a glycoprotein, seems to play a very important role in both the progression and invasion of cancer. The aim of this study was to evaluate cellular fibronectin (cFN) in the urine and blood of patients with TCC of the bladder and to determine its possible role as a tumor marker and prognostic factor. Morning urine samples and blood were collected from 20 patients (8 women, 12 men, mean age 69.9 years) before they underwent transurethral resection of bladder tumors (TURB). Twenty patients (10 women, 10 men, mean age 63.4 years) with nonmalignant urological disorders were recruited as the control group. Determination of cFN in plasma and urine was performed by using a newly developed time-resolved fluorescence immunoassay (TRFIA). Patients with nonmalignant diseases had mean cFN plasma levels of 404 ng/ml (range 181-746 ng/ml). Patients with TCC of the bladder showed significantly higher cFN plasma levels of 686 ng/ml (range 274-1999 ng/ml, p<0.05). Subdivided according to the TNM system, muscle-invasive bladder tumors (n=5) demonstrated higher cFN plasma levels (mean 944 ng/ml) than superficial bladder tumors (n=15, mean 463 ng/ml). There were no differences of plasma cFN concentrations concerning tumor grade and also no differences in urine levels between the different groups. We found a significant difference (p<0.04) of cFN plasma levels between patients with TCC of the bladder and the control group. The difference in cFN plasma levels between pTa/pT1 and >or=pT2 tumors indicates a clinically useful potential of this tumor marker for preoperative staging and postoperative follow-up. Our data underline the important but still unclear role of cFN as a tumor marker in TCC, and this will be the focus of future studies.     

膀胱移行细胞癌复发风险评价

目的　探讨与膀胱移行细胞癌复发时间相关的显著因素以对膀胱肿瘤患者预后作出准确评价。方法　应用COX风险比例回归方法,对200例膀胱移行细胞癌患者的临床表现、治疗、病理特点及免疫组化检测方面的20项因素与复发时间进行统计分析。结果　肿瘤数目是与复发时间相关最显著的因素,相对风险度（Hr)为3.47（P<0.01),其次为是否应用术中化疗(Hr=0.15,P<0.01)、肿瘤p53表达程度(Hr=1.89,P<0.01)、VEGF表达程度(Hr=1.60,P<0.01)。结论　根据上述四个因素对膀胱移行细胞癌患者预后可作出较为准确的评价,并对肿瘤复发时间进行估计。     

膀胱移行细胞癌复发风险多因素分析

目的：探讨与膀胱移行细胞癌复发时间相关的显著性因素，建立预测复发的数学模型。方法：应用Cox比例风险模型和Logistic线性回归方法对212例行手术治疗的膀胱移行细胞癌的临床表现、治疗、病理特点等方面16项指标与复发时间进行统计分析。结果：区域淋巴结转移是与复发时间相关的最显著因素，相对危险(Hr)为6．6，其次为多发性肿瘤(Hr=2．255)、三角区及膀胱颈肿瘤(Hr=2．053)、病理分期(Hr=2．057)、病理分级(Hr=1．569)；膀胱灌注治疗(Hr=0．559)和血尿程度(Hr=0.762)为保护性因素。据此建立影响膀胱癌术后复发的预测方程：PI=0．81305X4 0．71935X6(1) 0．36979X7 0．4507X8 0．72117X9 1．887llX10 (-0．58079)X14 (-0．2713)X15。代入原始数据，计算预测值，并将预测结果与实际结果比较，其灵敏度、特异度、及符合率分别为83．5％、67．6％、80．1％，两者基本相符。结论：根据上述模型可对移行细胞癌患者的预后做出较为准确的评价。     

Immunological profile of patients with transitional cell carcinoma of the bladder

The immunological profile of 58 patients with various stages of transitional cell carcinoma of the bladder was determined by using the local xenogeneic graft versus host reaction (GVHR) test, by skin testing with 3 recall antigens (candida, trichophyton, streptokinase-streptodornase) and by quantification of T-lymphocytes. Thirty-two patients with low grade low stage tumours (Group A) showed only a slight impairment of the immunological profile with a slight decrease in T-lymphocytes, 4.4% negative GVHR tests and 31.2% negative skin tests. Ten patients with highly invasive inoperable tumours (Group B) showed a severe impairment of the immunological profile with a significant decrease in T-lymphocytes, 100% negative GVHR and 80% negative skin tests. A marked improvement in the immunological profile was noted while comparing 9 patients who were examined within 6 months after cystectomy (Group CI) (severe decrease in T-lymphocytes 44.4% negative GVHR tests and 66.6% negative skin tests) with 7 patients who were examined 18 months or more after operation (Group CII) (slight decrease in T-lymphocytes 0% negative GVHR and 42.8% negative skin tests). Incubation of T-lymphocytes with a thymic hormone (THF) caused an increase in the extent of the graft versus host reaction in 10 out of 14 patients with low grade low stage bladder tumours. This may represent an improvement in the functional activity of the T-lymphocytes with a possible therapeutic use in the future.     

Ten cases of transitional cell carcinoma of bladder causing ureteric obstruction

A review was carried out on 10 patients with superficial transitional cell carcinoma of the bladder (Ta lesions) that were causing ureteric obstruction. Evidence of upper tract obstruction did not necessarily indicate deep invasion.     

Prognostic implications of lymphangiogenesis in muscle-invasive transitional cell carcinoma of the bladder

OBJECTIVES: Aim of the study was to describe and evaluate the association of lymph vessel density with clinicopathological parameters and survival in patients with muscle-invasive transitional cell carcinoma (TCC) of the bladder. METHODS: The data on 108 patients with muscle-invasive bladder TCC, who underwent radical cystectomy, were reviewed retrospectively. Sections were analysed immunohistochemically for D2-40, a specific lymphatic endothelial cell (LEC) marker. Counts of lymph vessels were taken in intratumoural and peritumoural areas as well as in normal tissue. To detect proliferating LECs, we performed a double immunostaining for D2-40 and the proliferation marker Ki-67. RESULTS: Peritumoural vessels were observed in 105 (97.2%) sections and intratumoural vessels in 65 (60.2%). Higher intratumoural lymph vesseI density (LVD) correlated significantly with poor histological differentiation (p=0.01). Higher peritumoural LVD showed a significant association with the presence of lymph node metastasis (p=0.0004). However, LVDs had no statistically significant influence on survival. Intratumoural and peritumoural lymph vessels showed proliferating LECs in varying proportions in all examined samples. CONCLUSIONS: The present study is the first to suggest the existence of proliferating lymph vessels, and, therefore, of lymphangiogenesis in bladder TCC. To our knowledge, it is also the first to confirm a strong correlation of higher peritumoural LVD with the presence of lymph nodes in clinically localized invasive bladder TCC. These findings indicate that lymphangiogenesis may contribute to tumour dissemination and thus provide a potential target for bladder cancer therapy.     

Clinical study of transitional cell carcinoma of the prostate associated with bladder transitional cell carcinoma

BACKGROUND: Transitional cell carcinoma of the prostate in patients with bladder cancer appears to influence the prognosis and affects the decision about therapeutic modality. Therefore, it is important to characterize transitional cell carcinoma associated with bladder cancer. METHODS: From April 1980 to December 1998, 81 male patients underwent total cystoprostatectomies for transitional cell carcinoma of the bladder. The 81 cystoprostatectomy specimens were examined to clarify the characteristics of prostatic involvement by transitional cell carcinoma. The extent, origin, mode of spread and risk factor of prostatic involvement as well as the prognosis were investigated. In 13 of 15 patients with prostatic involvement the prostate was examined by sequential step sections. RESULTS: Prostatic involvement was observed in 15 of 81 patients (18.5%). Prostatic urethral involvement, invasion to prostatic duct/acinus, prostatic stromal invasion and extraprostatic extension and/or seminal vesicle involvement were recognized in 12 (80%), 14 (93.3%), six (40%), and five (33.3%) of the 15 patients, respectively. Twelve of the 15 patients (80%) with prostatic involvement had papillary or non-papillary tumors (i.e. carcinoma in situ) both in the prostatic urethra and prostatic duct. In 10 of these 12 patients (88.3%), there was contiguity between prostatic urethral and ductal tumors. Seven of the 23 patients (30.4%) with carcinoma in situ of the bladder showed prostatic involvement, which increased to 50% in the presence of carcinoma in situ of the trigone or bladder neck. CONCLUSIONS: Eighty per cent of the patients with prostatic involvement showed papillary or non-papillary tumors both in the prostatic urethra and prostatic duct. There was a high level of contiguity between both tumors. Patients with carcinoma in situ of the trigone or bladder neck revealed significantly higher incidence of prostatic involvement.     

Antigenic deletion and prognosis of patients with stage A transitional cell bladder carcinoma.

The mixed cell agglutination reaction was studied in 22 patients with stage A transitional cell bladder tumors. The absence of antigens on the original tumor was found to correlate with development of invasive cancer on followup. The presence of antigens on the original tumor correlated with failure to develop stage B or greater disease within 5 to 14 years of followup.     

膀胱移行细胞癌预后因素分析

目的 探讨影响膀胱移行细胞癌患者术后生存率、复发、进展、转移及生活质量五个预后指标的临床及病理因素.方法 回顾性研究分析206例膀胱癌患者的临床资料,生存率由寿命表法评估,患者临床及病理特征(单因素)对患者预后的预测能力用Log-rank检验评估,选择单因素分析有统计学意义的变量进行Cox比例风险回归模型多因素分析.采用欧洲癌症研究与治疗组织(EoRTC)QLQ-C30量表评估膀胱癌患者术后生活质量情况.结果 206例中,最终生存155例,死于膀胱癌33例,死于其他疾病18例.总体3年、5年生存率分别为84.7%和69.9%.3年、5年的复发率分别为36.8%、44.7%,影响复发的主要因素是年龄、组织学分级、术后膀胱灌注.3年、5年的进展率分别为9.9%、13.3%,影响进展的主要因素是组织学分级、术中输血、复查频率及首次无复发间期(RFP).3年、5年转移率分别为8.9%、10.2%,影响转移的主要因素为肿瘤数目、组织学分级、术后膀胱灌注及RFP.影响术后生活质量的主要因素为年龄、手术方式、复查频率.结论 年龄、组织学分级、术后膀胱灌注、术中输血、复查频率、RFP、肿瘤数目、手术方式是影响膀胱癌预后的主要因素.     

Disease-centred advice for patients with superficial transitional cell carcinoma of the bladder

INTRODUCTION: Urologists tend to regard superficial tumours (e.g. pTa or pT1 transitional cell carcinoma of the bladder) as being of low pathogenicity. There is a clearly established link between cigarette smoking and bladder cancer, with incidence, recurrence and mortality being positively associated with duration of smoking and number of cigarettes smoked. PATIENTS AND METHODS: A questionnaire-based audit was undertaken to determine the amount of information being provided by urologists for patients who had been diagnosed with pTa or pT1 transitional cell carcinoma of the bladder about both their disease, its aetiology and appropriate advice regarding life-style change. RESULTS: A total of 78 patients adequately completed the questionnaire. Of these, 55 (71%) had been smokers at some time, and 24 (31%) continued to smoke at the time of follow-up. Only 26 of these 55 (47%) were aware of their underlying diagnosis. This level of knowledge was similar in non-smokers, of whom only 12 (52%) were aware of their disease. Of the ever-smokers, only 12 (22%) were aware that smoking was a risk factor for the development of bladder cancer, and 7 (13%) were aware that continued smoking could worsen the prognosis. Only 18 (33%) of the 55 smoking patients had been told to stop smoking, for any reason, by their general medical practitioner, and only 4 (7%) had been told to stop by a urologist. CONCLUSION: In the urology department in which the audit was performed, patients with bladder cancer were not being provided with adequate information about their disease.     

Cell-mediated tumour immunity in patients with transitional cell carcinoma of the urinary bladder

Some recent data on problems of cell-mediated immune reaction directed against tumour-associated antigens (TAA) of transitional cell carcinomas of the urinary bladder (BTCC) are reviewed. All of the 13 samples of BTCC examined in our laboratory using a lymphocytotoxicity microassay contained the characteristic TAA of urinary bladder carcinomas. TAA were absent in 14 control tissue samples. Forty-seven out of 70 (67%) patients with BTCC developed cytotoxic lymphocytes reacting, with BTCC cells. However, cytotoxic lymphocytes were also found in the blood of 8 out of 165 (4.8%) control lymphocyte donors.     

输尿管移行细胞癌预后影响因素分析

目的提高输尿管移行细胞癌的治疗效果。方法对获随访的３５例输尿管移行细胞癌预后影响因素作回顾性分析。结果输尿管肿瘤３年生存率为５４％，５年生存率为４６％，单发输尿管上中段癌３年、５年生存率分别为８６％和８６％，明显高于下段癌的４３％和２９％（Ｐ＜０．０５）。细胞分级：Ｇ１４例无１例死亡；Ｇ３３年、５年生存率分别为３１％和２３％，明显低于Ｇ２的６６％和５０％（Ｐ＜０．０１）。以临床分期统计其３年、５年生存率：Ｔ１１００％和８３％；Ｔ２６５％和５５％（Ｐ＞０．０５）；Ｔ３均于３年内死亡。结论输尿管移行细胞癌预后差，输尿管下段癌预后最差，肿瘤细胞分化程度及浸润深度是决定预后的主要因素。     

Evaluation of the immunocompetence of patients with transitional cell carcinoma of the bladder

Summary The cellular immunocompetence was examinded by means of the quantitative DNCB hypersensitivity reaction in 152 patients with transitional cell carcinomas of the bladder of Broders grades 1–4. Agains⁺, a control group of 367 normal controls of both sexes, 85 patients with transitional cell carcinomas of grades 1 and 2 showed a normal DNCB reactivity, irrespective of the frequency of tumour recurrence. In 9 patients of this group, an increase of malignancy from grade 2 to grade 3 was observed; the simultaneous deterioration of immunocompetence, however, was not statistically significant. On the other hand, with transitional cell carcinomass of grades 3 and 4, significant impairment of immunocompetence correlating with the tumour stage was noted.