MANAGEMENT OF TRANSITIONAL-CELL CARCINOMA INVOLVING VON BRUNNS NESTS

We reviewed data collected from 371 patients with superficial transiti onal cell carcinoma of the bladder to determine whether carcinoma with in von Brunn's nests is a risk factor for cancer progression and an in dication for radical cystectomy. Cystectomy was done in 20 of 73 patie nts (27%) with transitional cell carcinoma in von Brunn's nests and in 42 of 298 patients (14%) without von Brunn's nest involvement. There was no significant difference in the Kaplan-Meier crude and disease-sp ecific survival between patients with and without transitional cell ca rcinoma in von Brunn's nests, irrespective of whether radical cystecto my was performed initially. Of those patients with von Brunn's nest in volvement none who underwent cystectomy died of bladder carcinoma, whi le 3 (6%) managed conservatively died of bladder cancer. Of those pati ents without von Brunn's nest involvement 1 (5%) managed with cystecto my and 9 (4%) managed conservatively died of bladder carcinoma. Furthe rmore, only 8 patients (15%) with and 29 (11%) without transitional ce ll carcinoma in von Brunn's nests showed disease progression after ini tial conservative management. Based on this analysis, our conclusion i s that transitional cell carcinoma within von Brunn's nests is not a r isk factor for disease progression or an absolute indication for radic al cystectomy.