Primary carcinoma of the gallbladder

Seventy-four patients with primary carcinoma of the gallbladder, diagnosed over 18 years from 1969 to 1987, were studied retrospectively. The most common presenting complaint was abdominal pain, followed by jaundice and weight loss. Surgery was performed in 61 patients and of these patients, only two had accurate preoperative diagnosis which was made by ultrasonography. Twelve of the 13 patients who were treated medically had the disease diagnosed at autopsy. One of the 13 patients had the diagnosis of gallbladder cancer by the findings of ultrasonography and abdominal computed tomography (CT) scanning. The resectability of the surgically managed group was 36.1%, and the majority of patients with advanced tumors (82.2%) were deemed unresectable. The most common histologic type was adenocarcinoma. Liver was the organ most commonly invaded (76.5%) by direct extension and/or metastases, followed by regional lymph nodes (52.9%). The overall 5-year survival rate was 5.4%. A high index of suspicion of the disease, intraoperative examination of gallbladder specimen, and earlier, more aggressive surgical treatment may improve patient survival.     

Carcinoma of the gallbladder. Histologic types, stage of disease, grade, and survival rates.

Data on patients with gallbladder cancer listed in the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute were reviewed. Between 1977 and 1986, 3038 patients were recorded in the Program. Histologic grade, histologic type, stage of disease, and vascular invasion were correlated with outcome. Compared with all other histologic types of cancer, papillary carcinomas had the most favorable prognosis. The 2-year survival rate for patients with papillary carcinoma was 47%. A correlation with survival existed between grade, stage of disease, and vascular invasion. The study confirmed that cancers of the gallbladder occur more often in older age groups and are more common in women. Almost 40% of cases are found at an advanced stage. For patients whose enolase tumor was limited to the gallbladder at the time of surgery, the 2-year survival rate was 45% and the 5-year rate was 32%.     

副乳腺癌38例临床与病理分析

目的:探讨副乳腺癌（accessory breast cancer）的临床病理特征、诊断、综合治疗和预后。方法:对我院本组1985年10月～2007年11月收治的38例副乳腺癌患者的临床病理特点、诊断、治疗方法和预后做了回顾性分析总结。结果:38例副乳腺癌占同期全部乳腺癌26078 例的0.15% 。本组病例中,6 例I 期患者和3 例Ⅱ期患者行保留乳房的肿物局部广泛切除加腋窝淋巴结清扫术,切缘病理阴性;余9 例Ⅱ期患者行改良根治术,Ⅲ～Ⅳ期患者行改良根治术或根治术。组织学类型中最常见的为浸润性导管癌18例（47.4%）,其中3 例伴同侧乳头管腺瘤;单纯癌6 例,导管内癌6 例,腺癌伴灶性鳞癌分化3 例,髓样癌3 例,黏液腺癌2例。病理分期（根据AJCC乳腺癌分期,2002年第6 版）中最常见的为Ⅱ、Ⅲ期,各12例（31.6％）;Ⅰ期6 例,Ⅳ期8 例。全部患者随访1～23年,中位随访时间为6 年7 个月,随访率100% 。随访至2008年11月,12例发生远处转移并死于该病,余26例健在。本组5?年总生存率为35.3%（低于乳腺癌术后5 年生存率66.8% ,P<0.05）,3 年为77.8% ;5 年无瘤生存率为28.6% ,3 年为63.6% 。结论:副乳腺癌是一种罕见且预后较差的恶性肿瘤。诊断主要依靠临床表现、影像学检查和术后病理诊断。应遵循以手术为主的综合治疗原则,术后辅助治疗有可能改善患者的生存期。      

Gastric cancer treatment in Japan: 2008 annual report of the JGCA nationwide registry

The Japanese Gastric Cancer Association (JGCA) started a new nationwide gastric cancer registry in 2008. Approximately 50 data items, including surgical procedures, pathological diagnoses, and survival outcomes, for 12004 patients with primary gastric cancer treated in 2001 were collected retrospectively from 187 participating hospitals. Data were entered into the JGCA database according to the JGCA Classification of gastric carcinoma, 13th edition and the International Union Against Cancer (UICC) TNM Classification of malignant tumors, 5th edition by using an electronic data collecting system. Finally, data of 11261 patients with gastric resection were analyzed. The 5-year follow-up rate was 83.5%. The direct death rate was 0.6%. TNM 5-year survival rates (5YSRs)/JGCA 5YSRs were 91.8/91.9% for stage IA, 84.6/85.1% for stage IB, 70.5/73.1% for stage II, 46.6/51.0% for stage IIIA, 29.9/33.4% for stage IIIB, and 16.6/15.8% for stage IV. The proportion of patients more than 80?years old was 7.0%, and their 5YSR was 48.7%. Compared to the JGCA archived data, though the follow-up rate needs to be improved, these data suggest that the postoperative results of patients with primary gastric carcinoma have improved in those with advanced disease and in the aged population in Japan.     

Adjuvant external beam radiation therapy with concurrent chemotherapy in the management of gallbladder carcinoma.

PURPOSE: This study was performed to evaluate the outcome of patients with gallbladder cancer who received postoperative concurrent chemotherapy and radiation therapy. METHODS AND MATERIALS: Curative resection followed by adjuvant combined modality therapy with external beam radiation therapy (EBRT) and chemotherapy was attempted in 21 consecutive gallbladder carcinoma (GBC) patients at the Mayo Clinic from 1985 through 1997. All patients received concurrent 5-fluorouracil during EBRT. EBRT fields encompassed the tumor bed and regional lymph nodes (median dose of 54 Gy in 1.8-2.0-Gy fractions). One patient received 15 Gy intraoperatively after EBRT. A retrospective analysis was performed for the end points of local control, distant failure, and overall survival. RESULTS: After maximal resection, 12 patients had no residual disease on pathologic evaluation, 5 had microscopic residual disease, and 4 had gross residual disease. One patient had Stage I disease, and 20 had Stage III-IV disease. With median follow-up of 5 years (range: 2.6-11.5 years), 5-year survival for the entire cohort was 33%. The 5-year survival rate of patients with Stage I-III disease was 65% vs. 0% for those with Stage IV disease (p < 0.02). For patients with no residual disease, 5-year survival was 64% vs. 0% for those with residual disease (p = 0.002). The median survival was 0.6, 1.4, and 5.1 years for patients with gross residual, microscopic residual, and no residual disease, respectively (p = 0.02). The 5-year local control rate for the entire cohort was 73%. Two-year local control rates were 0%, 80%, and 88% for patients with gross residual, microscopic residual, or no residual disease, respectively (p < 0.01). Five-year local control rates were 100% for the 6 patients who received total EBRT doses >54 Gy (microscopic residual, 3 patients; gross residual, 1 patient; negative but narrow margins, 2 patients) vs. 65% for the 15 who received a lower dose (3, gross residual; 2, microresidual; 10, negative margins). CONCLUSION: Patients with completely resected (negative margins) GBC followed by adjuvant EBRT plus 5-fluorouracil chemotherapy had a relatively favorable prognosis, with a 5-year survival rate of 64%. These results seem to be superior to historical surgical controls from the Mayo Clinic and other institutions, which report 5-year survival rates of approximately 33% with complete resection alone. Both tumor stage and extent of resection seemed to influence survival and local control. More aggressive measures using current cancer therapies and integration of new cancer treatment modalities will be required to favorably impact on the poor prognosis of patients with Stage IV or subtotally resected GBC. Additional investigation leading to earlier diagnosis is warranted, because most patients with GBC present with advanced disease.     

Lower survival rate for patients under 30 years of age and surgically treated for gastric carcinoma

We analysed data on 38 patients with gastric cancer aged 30 years and younger who were surgically treated in the Department of Surgery II, Kyushu University Hospital, between 1965 to 1985. These younger patients comprised 2.6% of the total 1,470 patients treated for gastric cancer during this 21-year period. The durations and the kinds of symptoms in the preoperative period varied with the patient. In patients under 30 years of age, the female patients predominated, and in addition, undifferentiated lesions were more common than the differentiated type, tumours were larger, serosal invasion was more prominent, lymphatic involvement was more common, tumours showed infiltrative growth and the rate of peritoneal dissemination was higher. Consequently the survival rates for these younger patients were poor. Detection at an early stage of the disease is mandatory if the survival rates of younger patients with gastric cancer are to improve.     

Potential utility of liquid biopsies in the management of patients with biliary tract cancers: A review

Biliary tract cancer, comprising gallbladder cancer, cholangiocarcinoma and ampullary cancer, represents a more uncommon entity outside high-endemic areas, though global incidence is rising. The majority of patients present at a late stage, and 5-year survival remains poor. Advanced stage disease is incurable, and though palliative chemotherapy has been shown to improve survival, further diagnostic and therapeutic options are required in order to improve patient outcomes. Although certain subtypes of biliary tract cancer are relatively rich in targetable mutations, attaining tumour tissue for histological diagnosis and treatment monitoring is challenging due to locoregional anatomical constraints and patient fitness. Liquid biopsies offer a safe and convenient alternative to invasive procedures and have great potential as diagnostic, predictive and prognostic biomarkers. In this review, the current standard of care for patients with biliary tract cancer, future treatment horizons and the possible utility of liquid biopsies within a variety of contexts will be discussed. Circulating tumour DNA, circulating microRNA and circulating tumour cells are discussed with an overview of their potential applications in management of biliary tract cancer. A summary is also provided of currently recruiting clinical trials incorporating liquid biopsies within biliary tract cancer research.     

Management of carcinoma of the gallbladder: a single-institution experience in 16 years

BACKGROUND: Radical surgery is the only curative treatment for carcinoma of gallbladder. This study aimed to evaluate the outcome of patients with carcinoma of gallbladder managed in a single institution over 16 years. METHODS: From April 1988 to November 2003, 86 patients (29 males, 57 females) were diagnosed to have carcinoma of gallbladder. Tumor staging, treatment modalities and clinical outcome of these patients were evaluated. Thirty-two patients (37%) had early stage (TNM stage I or II) disease whereas 54 patients (63%) had advanced stage (TNM stage III or IV) disease. Curative treatment by surgical resection was performed in 23 patients (27%). RESULTS: Overall survival was significantly better in patients with curative treatment (1-year: 85%; 2-year: 63%; 3-year: 55%) than those with palliative treatment (1-year: 11%; 2-year: 3%; 3-year: 0%; P < 0.01). Using Cox regression model, curative treatment was the only independent prognostic factor affecting overall survival of patients with carcinoma of gallbladder. A significantly better survival was associated with curative treatment compared with palliative treatment in patients with incidental gallbladder cancer. The median survival was 33.9 months for the curative treatment group versus 3 months for the palliative treatment group (P = 0.0001). CONCLUSION: Favorable survival outcome can be achieved in patients with carcinoma of gallbladder after curative resection.     

Analysis of prognostic factors after surgery for stage III and IV gallbladder cancer.

AIM: Survival and prognostic factors were analysed in patients who had undergone surgical resection with curative intention with the aim of identifying groups of patient with stage III and IV gallbladder cancer on the TNM classification who might benefit from surgery. METHODS: Thirty-seven patients with advanced gallbladder cancer were studied, the cumulative survival rate for each group was calculated for each pTNM factor. RESULTS: The 5-year survival rates in the stage III patients were 83.3%, while those for the stage IVA patients were 46.2%, and those for the stage IVB patients 16.7%. CONCLUSIONS: In patients with invasion of adjacent organs, including the liver and gastrointestinal tract, and rated as pT3 or pT4, extended surgery excising the invaded tissue may be justified. In patients with pN2 lymph-node metastasis, even without adjacent organ invasion, radical surgery may not achieve a good outcome.     

Retrospective analysis of prognosis for scirrhous-type gastric cancer: one institution's experience

Background Scirrhous gastric cancer is biologically aggressive, and the prognosis is poor even with curative surgery. We compared outcomes with different therapies in order to identify prognostic factors. Methods Records for 83 patients, who were treated between 1991 and 2004, were evaluated for survival and stage, treatment, and clinicopathological factors. Results Cumulative 5-year overall survival was 10.2% for all 83 patients, including 27 (32.5%) patients with stage II/III disease and 56 (67.4%) with stage IV disease. The 5-year overall survival rate and median survival time for patients with stage II/III disease after curative surgery were 24.3% and 1150 days. For patients with stage IV disease, 2-year and 5-year survival rates after initial surgery were 13.7% and 0% and median survival was 250 days. In contrast, preoperative chemotherapy for advanced, unresectable disease produced 2-year and 3-year overall survival rates of 53.6% and 26.8% and medican survival was 910 days. Conclusion Aggressive surgery alone does not seem to improve outcome, but preoperative chemotherapy might be beneficial and should be investigated further.     

76例早期胆囊癌的诊断及手术治疗预后分析

目的：探讨早期胆囊癌的诊断方法及术后预后的影响因素。方法选择76例早期胆囊癌患者,通过整理相关临床资料,对所有患者的治疗方法以及对影响患者预后的相关因素予以分析。结果采取单纯胆囊切除术中Ⅰ期患者24例,Ⅱ期患者21例;采取胆囊癌标准根治术中Ⅰ期患者5例,Ⅱ期患者14例;采取胆囊癌扩大根治术中Ⅰ期患者2例,Ⅱ期患者10例。所有患者术后均未出现死亡情况。1年生存率为100．00％,3年生存率为75．00％,5年存活率为44．74％。手术方式、Nevin分期、肿瘤所在位置、分化程度、黄疸为影响早期胆囊癌手术治疗预后的独立因素。结论根据早期胆囊癌患者不同的病理分期以及实际的侵犯范围,采取相应的手术治疗方式,能够提高患者的预后,延长生存时间。及时发现、正确的手术方式是提高其预后、延长生存期的关键。     

Gallbladder cancer

Gallbladder cancer has a reputation for being aggressive and incurable. Single institution series, however, have defined successful management strategies in which the extent of resection is based on the stage of the tumor at presentation. Careful ultrasound screening for abnormalities in the gallbladder wall, and CA19-9 serum determination prior to routine cholecystectomy may heighten awareness for cancer in this population. For tumors confined to the muscular layer of the gallbladder a simple cholecystectomy is associated with an almost 100% cure rate. Tumors invading through the muscle wall (Stage II) should be managed with extended cholecystectomy, including resection of hepatic segments IVb and V, and an extensive lymph node dissection of the porta hepatis, posterior pancreaticoduodenal, and interaortocaval lymph nodes. This operation for Stage II gallbladder cancer is associated with a 90% to 100% 3-year survival rate. Simple cholecystectomy fails in the majority of Stage II patients. Patients with Stage III and IV tumors may also benefit from an extended cholecystectomy. Patients with bulky primary tumors without lymph node metastases (T4N0) seem to have a better prognosis than those with distant lymph node metastases, and should be treated aggressively when possible. It is advantageous to perform the appropriate extent of surgery for gallbladder cancer at the initial operation. Heightened awareness of the presence of cancer and the knowledge of appropriate management are important. For patients whose cancer is an incidental finding on pathologic review, re-resection is indicated for all disease except Stage I. This review will discuss the epidemiology, pathology, and staging of gallbladder cancer and describe the appropriate surgical management based on the stage of the cancer.     

手术治疗颜面部皮肤癌的长期疗效观察

目的：探讨手术治疗颜面部皮肤癌的长期疗效。方法选取颜面部皮肤癌患者83例,所有患者均行手术治疗。对手术治疗的临床疗效进行观察。结果83例患者术后5年生存率为77．11％,10年生存率为61．45％。基底细胞癌患者5年和10年生存率分别为86．79％和73．58％,均明显高于鳞状细胞癌患者的60．00％和40．00％（P＜0．05）。临床分期为T1期的患者5年和10年生存率分别为89．58％和72．92％,T2期的患者5年和10年生存率分别为61．54％和50．00％,T3期的患者5年和10年生存率分别为55．56％和22．22％,组间比较差异明显（ P＜0．05）。结论手术对颜面部皮肤癌具有较好的治疗效果,患者术后生存期较长。     

Surgical strategies in patients with gallbladder cancer: nihilism to optimism

INTRODUCTION: Gallbladder cancer is an aggressive disease with dismal results of surgical treatment and a poor prognosis. However, over the last few decades selected groups have reported improved results with aggressive surgery for gallbladder cancer. METHODS: Review of recent world literature was done to provide an update on the current concepts of surgical treatment of this disease. RESULTS: Long-term survival is possible in early stage gallbladder carcinoma. Tis and T1a gallbladder carcinoma can be treated with simple cholecystectomy only. However, in T1b and beyond cancers, aggressive surgery (extended cholecystectomy) is important in improving the long-term prognosis. Laparoscopic cholecystectomy should not be performed where there is a high index of suspicion of malignancy due to the frequent association with factors (such as gallbladder perforation and bile spill) which may lead to implantation of cancer cells and dissemination. Surgical resection for advanced carcinoma gallbladder is recommended only if a potentially curative R0 resection is possible. Aggressive surgery with vascular and multivisceral resection has been shown to be feasible albeit with an increase in mortality and morbidity. However, the true benefit of these radical resections is yet to be realized, as the actual number of long-term survivors of advanced gallbladder carcinoma is few. CONCLUSIONS: Surgery for gallbladder carcinoma, like other malignancies, has the potential to be curative only in local or regional disease. Pattern of loco-regional spread of disease dictates the surgical procedure. Radical surgery improves survival in early gallbladder carcinoma. The long-term benefit of aggressive surgery for advanced disease is unclear and may be offset by the high mortality and morbidity.     

Primary carcinoma of the gallbladder in Taiwan

To define more precisely the prognostic index for patients with primary carcinoma of the gallbladder in Taiwan, we retrospectively reviewed the data of 74 patients with gallbladder carcinoma treated over a period of 15 years, from 1979 to 1993. Of these patients, 75% had Nevin stage V gallbladder cancer. The most common presenting complaint was abdominal pain, followed by jaundice, fever, and nausea and vomiting. Accurate preoperative diagnosis was made in 29.7% of the patients. Ultrasonography and computed tomography had a diagnostic accuracy of 34.0% and 40.9%, respectively. The most common histologic type was adenocarcinoma. Liver was the organ most commonly invaded (51.9%) by direct extension and/or metastases, followed by regional lymph nodes (38.5%). The overall 5-year survival rate was 4.1%. Age, sex, white cell count, hemoglobulin, SGOT, SGPT, total bilirubin, alkaline phosphatase, and cholelithiasis were not significant prognostic factors. Patients with cancers confined in the gallbladder wall (stages I, II, III) had a better (P < 0.05) cumulative survival rate than did those with regional lymph nodes and distant metastases. Cholecystectomy or extended surgery had a better survival rate than did palliative surgery, but there was no significant difference between cholecystectomy and extended surgery. High index of suspicion of the disease and earlier surgical treatment may improve patient survival. © 1996 Wiley-Liss, Inc.     

Management of cancer gallbladder found as a surprise on a resected gallbladder specimen

Carcinoma gallbladder is associated with an overall 5-year survival rate reported less than 5% due to late diagnosis. Advent of ultrasound scanning may help in detecting gallbladder polyps and an early gallbladder cancer. Excellent 5-year survival (up to 100%) has been reported for Stage Ia disease and the survival has significantly improved for Stage Ib, II, and III if appropriate re-operation is carried out soon after the incidental detection of gallbladder cancer. Laparoscopic cholecystectomy (LC) is contraindicated in the presence of gallbladder cancer. It is recommended to excise all laparoscopic port sites, at the time of re-operation. Re-operation for Stage II gallbladder cancer is associated with a 90-100% 3-year survival rate. Patients with Stage III and IV tumors also benefit from an extended cholecystectomy. Patients with bulky primary tumors without lymph node metastases (T4N0) seem to have a better prognosis than those with distant lymph node metastases, and should be treated aggressively. It is advantageous to perform the appropriate extent of surgery for gallbladder cancer at the initial operation. Heightened awareness of the presence of cancer and the knowledge of appropriate management are important. For patients whose cancer is an incidental finding on pathologic review, re-resection is indicated for all disease except Stage Ia. Radiotherapy and chemotherapy have not been found effective as an adjuvant or palliative therapy in gallbladder cancer.     

Gastric cancer treated in 2002 in Japan: 2009 annual report of the JGCA nationwide registry

Background

The Japanese Gastric Cancer Association (JGCA) started a new nationwide gastric cancer registration in 2008.

Methods

From 208 participating hospitals, 53 items including surgical procedures, pathological diagnosis, and survival outcomes of 13,626 patients with primary gastric cancer treated in 2002 were collected retrospectively. Data were entered into the JGCA database according to the JGCA classification (13th edition) and UICC TNM classification (5th edition) using an electronic data collecting system. Finally, data of 13,002 patients who underwent laparotomy were analyzed.

Results

The 5-year follow-up rate was 83.3 %. The direct death rate was 0.48 %. UICC 5-year survival rates (5YEARSs)/JGCA 5YEARSs were 92.2 %/92.3 % for stage IA, 85.3 %/84.7 % for stage IB, 72.1 %/70.0 % for stage II, 52.8 %/46.8 % for stage IIIA, 31.0 %/28.8 % for stage IIIB, and 14.9 %/15.3 % for stage IV, respectively. The proportion of patients more than 80 years old was 7.8 %, and their 5YEARS was 51.6 %. Postoperative outcome of the patients with primary gastric carcinoma in Japan have apparently improved in advanced cases and among the aged population when compared with the archival data. Further efforts to improve the follow-up rate are needed.

Conclusions

Postoperative outcome of the patients with primary gastric carcinoma in Japan have apparently improved in advanced cases and among the aged population when compared with the archival data. Further efforts to improve the follow-up rate are needed.     

Early hilar lung cancer: its clinical aspect

Early hilar lung cancers are rare, but are curable if they are properly diagnosed and treated. In the past 14 years, we have treated 27 patients with early hilar cancers that fulfilled the criteria proposed by the Japanese Lung Cancer Society (JLCS). Eighteen patients presented with symptoms and 9 were detected by the mass screening examination of sputum cytology. All lesions in both groups were finally diagnosed by bronchoscopy. Twenty patients (74%) had positive sputum cytology, whereas only 7 (26%) had positive chest X-ray findings. All the patients underwent surgery, and bronchoplasty was the most frequent operative procedure. The 5-year survival rate was 100%, and the 10-year survival rate was 91.7%, as one patient died of a second primary lung cancer in the 6th postoperative year. In conclusion, the definition of early hilar lung cancer proposed by the JLCS is thought to be reasonable, and early hilar lung cancer is a curable disease, if it is properly diagnosed and treated.     

Breast cancer in women with HIV/AIDS: report of five cases with a review of the literature

BACKGROUND: The association of human immunodeficiency virus (HIV) infection with breast carcinoma is unclear. With improved survival of HIV-infected patients due to better understanding and treatment of the disease, there is likely to be an increase in incidence of breast cancer in women with HIV infection. METHODS: The medical records of 305 patients with breast cancer seen between January 1995 and December 2000 at Harlem Hospital Center, New York, where approximately 1,000 HIV-infected patients are treated yearly, were reviewed with attention to age, breast cancer stage at presentation, and patient survival. RESULTS: Breast cancer in the five HIV-infected patients has same median age distribution, disease stage, and pathologic characteristics as in the 300 HIV-indeterminate patients. Four of the five (80%) HIV-infected women compared to 79% in the HIV-indeterminate patients presented with early breast cancer (Stages I and II). Five-year survival in the HIV-infected patients is 80%, which is similar to the observed 70% 5-year crude survival rate in the indeterminate group. CONCLUSIONS: Our results do not support the recent reports suggesting that HIV infection is associated with poorly differentiated, aggressive disease with poor survival outcome. It remains unclear if breast carcinoma is directly linked to HIV infection.     

Results of adjuvant chemotherapy for invasive urothelial cancer with lymph-node metastasis

From 1980 to 1991, 59 patients with advanced urothelial cancer (pathological stage, >pT3) underwent radical operations. Of these 59 patients, 33 had nodal involvement. This study focused on those 33 patients with nodal involvement. The primary site was the urinary bladder in 20 patients and the upper urinary tract (renal pelvis and/or ureter) in 13. In all, 13 patients underwent adjuvant chemotherapy with an M-VAC or M-VEC [methotrexate (M), vinblastine, doxorubicin (ADM) or epirubicin, and cisplatin (CDDP)] regimen, and another 8 patients were treated with other insufficient chemotherapies [CDDP+ADM or CDDP+ADM_etoposide (VP-16)]. A group of 12 patients did not receive any additional treatment. Most of the patients in the M-VAC and M-VEC groups received more than 2 cycles of the regimen (median, 3.2 cycles; range, 1–9 cycles). The overall 5-year survival rate of the M-VAC and M-VEC group was 31%, whereas the rate was 0 for the other insufficient-chemotherapy groups and the no-chemotherapy group. Of the 13 patients in the M-VAC group, 4 (31%) patients were alive without disease progression and 9 (69%) were dead due to progressive disease. In the other groups, only I patient was alive without progression. Our results suggest that adjuvant M-VAC or M-VEC chemotherapy may extend the median survival of patients with advanced urothelial cancer, but it failed to reduce the rate of cancer death.Paper presented at the 5th International Conference on Treatment of Urinary Tract Tumors with Adriamycin/Farmorubicin, 24–25 September 1993, Hakone, Japan