A CLASSIFICATION AFTER RADICAL CYSTECTOMY OF PATIENTS WITH BLADDER-CANCER ASSOCIATED WITH SCHISTOSOMIASIS

The aim of this study was to classify the bilharzial bladder cancer pa tients after radical cystectomy into several prognostic strata with in creasing risk of recurrence. 310 patients through the period 1977-1983 at the National Cancer Institute of Cairo were systematically analyse d for 12 variables evaluated after radical cystectomy. Eight factors w ere shown to have a significant influence on the recurrence-free survi val curve after radical cystectomy namely: tumour stage, size, grade a nd location in the bladder, lymph node involvement, metastasis, renal insufficiency and urinary diversion. Using the proportional hazard mod el, five factors were significantly related to a lower recurrence-free survival, one major prognostic factor, tumour grade (G2 or G3) (relat ive risk estimate of 5.5), and four minor prognostic factors (relative risk estimates around 2), namely tumour diameter greater than 5 cm, a nterior or trigonal location of the tumour, tumour stage (T3 or T4) an d presence of renal insufficiency before surgery. Four prognostic stra ta have been defined in relation to the presence of these prognostic f actors. This classification was validated on a second sample of 122 pa tients by comparing for each prognostic stratum, the recurrence-free s urvival curve observed on this sample and the corresponding predicted curve by Cox model. No statistically significant difference could be d etected. This classification of bladder cancer patients appears to be adequate for bilharzial bladder cancer patients after radical cystecto my, at least in the conditions they presented and were treated for at the NIC in Cairo.