CLINICAL-VARIABLES WHICH SERVE AS PREDICTORS OF CANCER-SPECIFIC SURVIVAL AMONG PATIENTS TREATED WITH RADICAL CYSTECTOMY FOR TRANSITIONAL-CELL CARCINOMA OF THE BLADDER AND PROSTATE

Background. Studies have demonstrated conclusively that the stage and grade of transitional cell tumors at presentation are major determinan ts of survival for those with the disease in the bladder and prostate. The authors initiated a review of 531 patients with transitional cell carcinoma of the bladder and prostate treated with radical cystectomy between 1969 and 1990 to identify other clinical features predictive of cancer-specific survival. Materials and Methods. Inpatient and clin ical medical records were analyzed for age, race, gender, clinical T s tage, medical history, and presenting symptoms and signs, and admissio n laboratory values were correlated with the patient's cancer-specific outcome. Both univariate and multivariate analyses of the various cli nical factors were performed to identify variables predictive of cance r-specific survival. Results. Univariate analysis indicated that clini cal T classification, preoperative hemoglobin, tumor grade, irritative voiding symptoms, age, preoperative creatinine, obstructive hydroneph rosis on preoperative excretory urography, a history of bladder tumors or nephroureterectomy for transitional cell cancer, prior urinary tra ct infections, prior pelvic irradiation, and obstructive symptoms were all predictive of poor cancer-specific survival. Multivariate analysi s demonstrated that higher clinical T classification (T2, T3a, T3b, T4 versus Ta, Tis, T1) (P < 0.001), increasing age (< 65 years versus gr eater than or equal to 65 years) (P < 0.001), the presence of irritati ve voiding symptoms (P = 0.01), higher tumor grade, lower preoperative hemoglobin level (less than or equal to 12 gm/dl versus > 12 gm/dl) ( P < 0.001), higher preoperative creatinine level (greater than or equa l to 1.5 mg/dl versus < 1.5 mg/dl) (P = 0.002), a history of nephroure terectomy for transitional cell cancer (P = 0.016), and a history of p elvic irradiation (P = 0.002) were all predictive of poor cancer-speci fic survival. Conclusions. Although clinical T classification and tumo r grade remain the best predictors of survival in patients with transi tional cell carcinoma of the bladder or prostate, clinical variables s uch as age, preoperative creatinine and hemoglobin levels, a history o f nephroureterectomy or pelvic irradiation, and irritative voiding sym ptoms at presentation may provide additional prognostic information in dependent of tumor grade and stage.