THE PROGNOSTIC IMPORTANCE OF THE MORPHOLOGICAL SUBDIVISION OF THE GRADE-II SUPERFICIAL BLADDER-CANCER

In this study a morphological subdivision of grade (g)II superficial b ladder cancer is proposed and correlated with recurrence and progressi on rate. Forty patients, 33 males and 7 females, of 70 years mean age, with initial gII superficial transitional bladder cancer were treated with transurethral resection between January and December 1987 with f ollowup for a mean period of 4 years. Recurrences were observed in 24 patients. All histological specimens were reviewed and reclassified to gIIa and gIIb mainly according to the variation in nuclear size, the degree of nuclear atypia and the number of mitoses. 42.1% (8/19) of th e gIIa and 76.2% (16/21) of the gIIb tumors recurred. The observed dif ference in recurrence rate was statistically significant (s.s) p< 0.05 . The disease-free interval after the initial presentation was over tw o years in 50% (4/8) of gIIa and in 6.25% (1/16) of gIIb patients (s.s . difference p< 0.05). None of the patients with gIIa, but 37.5% (6/16 ) with gIIb urothelial cancer had more than two recurrences (s.s. diff erence - p< 0.05). All gIIa recurred as gIIa superficial cancers, 62.5 % (10/16) of gIIb as glib (5 superficial and 5 invasive) and the remai nder 37.5% (6/16) as invasive gIII tumors. Only one patient with repea ted recurrences died two years after the initial presentation. 3 patie nts died from other causes. In conclusion: 1. The morphological subdiv ision of gII urothelial cancer into gIIa and gIIb has a prognostic sig nificance, as it is related to the recurrence rate, the disease-free i nterval after the initial resection, the number of recurrences and the progression rate. 2. As gIIb urothelial cancer identifies patients at a higher recurrence risk, it is evident that this group requires an a djuvant treatment and a closer follow-up.