THE RELATIONSHIP AMONG MULTIPLE RECURRENCES, PROGRESSION AND PROGNOSIS OF PATIENTS WITH STAGES TA AND T1 TRANSITIONAL-CELL CANCER OF THE BLADDER FOLLOWED FOR AT LEAST 20 YEARS

A retrospective study was done on 176 patients with primary stages Ta and T1 bladder cancer treated between 1963 and 1972. One patient was l ost to followup after 6 years, while the remainder were followed to de ath or for at least 20 years. In 1993, 13 patients had no evidence of disease, 39 died of bladder cancer and 123 died of intercurrent diseas e. Of 77 patients with a primary noninfiltrating tumor and 99 with a p rimary lamina propria invasive tumor 9 (11%) and 30 (30%), respectivel y, died of bladder cancer. Recurrences were noted on 10 or more cystos copic studies in 16 patients and 10 died of bladder cancer 3.5 to 19 y ears after the primary transurethral resection. A total of 14 patients received repeated thiotepa instillations, all continued to have recur rences and 10 subsequently died of bladder cancer. Only 1 upper tract tumor was diagnosed on routine followup excretory urography. Invasive transitional cell carcinoma of the bladder developed in only 1 of 59 p atients who had been tumor-free for 5 years. The results indicate that patients with recurrences on 10 or more cystoscopic studies will cont inue to have recurrences until death or cystectomy. Recurrence more th an 4 years after the primary tumor operation is another ominous sign. Repeated thiotepa instillations did not influence the course of the di sease in patients with a history of multiple recurrences. Followup cys toscopy may be discontinued 5 to 10 years after the last recurrence, a t least in patients with a solitary low grade primary tumor. Routine f ollowup urographic studies are neither cost-effective, clinically indi cated nor justified in patients with superficial bladder cancer.