HISTOLOGICAL GRADING OF CARCINOMA IN-SITU OF THE BLADDER - ITS CLINICAL-SIGNIFICANCE IN PATIENTS WHO UNDERWENT INTRAVESICAL MITOMYCIN-C ANDDOXORUBICIN SEQUENTIAL THERAPY

Purpose: The clinical behavior of carcinoma in situ of the bladder see ms rather complicated. Although some have advocated the histological g rading of carcinoma in situ, to our knowledge no sufficient clinical i nformation has been reported. Therefore, we evaluated the clinical sig nificance of histological grading of carcinoma in situ of the bladder. Materials and Methods: From January 1984 to December 1991, 58 patient s with carcinoma in situ of the bladder were treated initially with in travesical mitomycin C and doxorubicin sequential therapy. Of the pati ents 20 had grade 2 and 38 had grade 3 anaplasia according to the modi fied World Health Organization grading system. Those who failed the in itial therapy received another course of mitomycin C and doxorubicin s equential therapy or intravesical bacillus Calmette-Guerin. Results: F ollowing initial therapy, 13 patients (65%) with grade 2 and 28 (74%) with grade 3 disease achieved a complete response. Subsequent intraves ical therapy resulted in complete response in 17 patients (85%) with g rade 2 and 31 (82%) with grade 3 cancer. The local recurrence rate was higher in the grade 2 than in the grade 3 cases after a median follow up of 48 months (range 10 to 84). The recurrent tumor configuration wa s significantly different between the 2 groups. Papillary cancer recur red only in grade 2 cases, while only nodular cancer recurred in grade 3 cases. The progression-free and survival curves were slightly highe r in grade 2 than in grade 3 cases, although the difference was not si gnificant. Conclusions: There may be some difference in response to in itial intravesical chemotherapy and the local recurrence rate between grades 2 and 3 carcinoma in situ, both of which are detrimental to gra de 2 lesions. Moreover, it appears likely that grade 2 carcinoma in si tu is a precursor of papillary high grade cancer and grade 3 carcinoma in situ is a precursor of nodular cancer. However, patient prognosis in the 2 groups was not significantly different.