PROGNOSIS AND TREATMENT OF T1G3 BLADDER-TUMORS - A PROGNOSTIC FACTOR-ANALYSIS OF 121 PATIENTS

Patients with T1G3 bladder cancer have a considerable risk for recurre nce and/or progressive disease. Until now no consensus has been achiev ed on the optimal treatment. Within the Dutch South Eastern Bladder Ca ncer Study Group, 155 patients with a T1G3 bladder tumour were seen be tween 1983 and 1988. After review of histology, 121 could be evaluated and recurrence-free interval was studied with regard to prognostic fa ctors. Prognostic factors such as sex, age, blood group, abnormalities on intravenous urography, pretreatment tumour configuration, number o f tumours, number of locations involved in the bladder, voided urine c ytology, results of random biopsies and mitotic index were evaluated, using a multivariate analysis with the Cox proportional hazard model. During the follow-up period, 70 (58%) patients had recurrent bladder c ancer, and of these 30 (43%) had progression into invasive disease. Of the possible prognostic factors analysed, only multiplicity (P = 0.03 ) and the number of locations of the tumours (P = 0.03) were independe nt prognostic factors in relation to the risk of recurrence. The recur rence-free interval was influenced by the therapy. For T1G3 tumours, a dditional intravesical immunotherapy/chemotherapy or radiotherapy afte r transurethral resection (TUR) increased the recurrence-free interval significantly. Because most other parameters did not show additional prognostic value, the T1G3 tumours can be considered as homogeneous wi th regard to prognosis. Only multiplicity and the number of locations involved added to the prognostic significance of patients with these b ladder tumours. In addition, it is advisable to give patients with T1G 3 tumours additional treatment after the initial TUR.