FACTORS AFFECTING RECURRENCE AND PROGRESSION IN SUPERFICIAL BLADDER-TUMORS

Prognostic factors in superficial bladder tumours are highly correlate d with each other. In this study, their relative importance is examine d and grouping of patients in three different prognostic groups sugges ted. 576 patients (from EORTC protocols 30790 and 30782) were analysed . They have been followed from 3 months to 8.6 years with a median of 4 years. 76 patients developed an invasive tumour (greater than or equ al to T2); the shortest time to invasion was 12 weeks, the longest was 6.6 years. Time from invasion to death ranged from 3 weeks to 4.4 yea rs with a median of 2 years. Prognostic factors contributing to recurr ence, invasion and survival were investigated: age, sex, size of large st tumour, number of tumours, T-category, G-grade, time from diagnosis (years), prior recurrence rate/year, site of involvement. The relativ e importance of these factors was measured by performing a multivariat e analysis based on Cox's proportional hazards regression model. Based on the most important prognostic factors and their association with i nvasion and death, an index was computed reflecting the risk of both i nvasion and death due to malignant disease, respectively. The index wa s used to assign patients to one of three prognostic groups. Three mai n factors determined patient's prognosis: tumour size, G-grade and pri or recurrence rate/year. The model coefficients for invasion were 0.51 (recurrence rate <1/year, 1-3/year, >3/year), 0.84 (grade 1, 2, 3), 0 .48 (size <1.5, 1.5-3, >3 cm) and for death due to malignant disease 0 .89 (recurrence rate), 0.73 (grade) and 0.44 (size), respectively. Ris k groups are suggested based on the index. Additional treatment in pat ients with superficial transitional cell carcinoma of the bladder may be decided depending on the risk group to which the patient belongs.