Korean J Med.
1999 Sep;57(3):333-347.
Prognostic factors of invasive bladder cancer
- Affiliations
-
- 1Department of Internal Medicine, Asan Medical Center, College of Medicine University of Ulsan, Seoul, Korea.
- 2Department of Urology, Asan Medical Center, College of Medicine University of Ulsan, Seoul, Korea.
Abstract
-
Transitional cell carcinoma(TCC) of the bladder is confined to mucosa or submucosa on initial
presentation. However, high grade superficial tumors tend to recur and progress to muscle
invasive or metastatic diseases. Regardless of radical cystectomy in invasive bladder cancer,
a poor prognosis was noted due to local recurrence and distant metastasis in recent studies.
In this study, the clinical and pathological factors affecting survival of patients with muscle
invasive bladder cancer were analyzed.
METHODS
A total of 105 patients with histopathologically
verified muscle invasive bladder cancer who were admitted to Asan Medical Center between
August 1989 and August 1998 were reviewed retrospectively. The clinical manifestations,
laboratory findings, and histopathological findings at initial diagnosis were evaluated.
Overall survival, disease free survival, and disease specific survival according to many
prognostic factors were also analyzed.
RESULTS
The factors affecting overall survival of muscle invasive bladder cancer were age,
sex, TNM stage, performance status, tumor size, invasion of deep bladder muscle, tumor grade,
lymphovascular invasion, and complete resection of tumors. In patients with completely resected
bladder cancer by radical cystectomy, tumor size, deep bladder muscle invasion, stage,
and lymph node involvement were significant prognostic factors. In patients who had either
incomplete resection of bladder cancer or in whom no operation was performed, the survival rate
was lower in cases with lymph node involvement or hemoglobin level of less than 10 g/dl.
CONCLUSION
After radical cystectomy, the recurrence rate appeared to be higher in solid tumors
with deep bladder muscle invasion and lymphovascular invasion on cystoscopic findings.
Overall survival was higher in patients with lower tumor stage, no lymph node involvement,
and completely resected bladder cancer. Age and sex had no significant correlation with overall
survival. No apparent survival advantage was noted in those patients who received post-operative
chemotherapy. However, prospective randomized controlled studies are necessary to evaluate the
benefit of adjuvant chemotherapy in muscle invasive bladder cancer.