INVASIVE, HIGH-GRADE TRANSITIONAL-CELL CARCINOMA OF THE BLADDER TREATED WITH TRANSURETHRAL RESECTION - A SURVIVAL ANALYSIS FOCUSING ON TUR AS MONOTHERAPY

Two hundred and fifteen consecutive patients admitted to our departmen t between 1978 and 1988 were included in a retrospective study. Entran ce criteria were transitional cell carcinoma of the bladder T1-4, Grad e III-IV. Status of nodes and metastases were not recorded. Initially all patients had a macroscopically radical transurethral resection (TU R). Patients were followed with cystoscopies. Recurrent tumours were t reated with repeated TUR (RE-TUR). In cases of progression to a higher T-stage or recurrences with multiple papillomas (>1 0), adjuvant ther apy was recommended. The patients were retrospectively allocated to th ree different groups. Group 1 had TUR only, Group 2 had TUR + adjuvant irradiation, and Group 3 had TUR and various adjuvant therapies (Tabl e I). Median crude actuarial overall survival was 29 months. In Groups 1, 2 and 3, median crude survival was 37, 13 and 32 months, respectiv ely. In the analysis, most emphasis was put on Group 1. For stages T1- 4 in this group, the median survivals was 67, 19, 9 and 2 months, resp ectively. Differences were statistically significant (p < 0.05). TI tu mour stage seemed to predict a reduced risk of progression compared wi th the higher tumour stages (p = 0.05, Fisher's test). There was a ten dency for females to progress less often than men, but the difference was not statistically significant. In conclusion, macroscopically radi cal TUR does not seem to offer the same cure rates as radical cystecto my. However, in a selected group of patients with a troublesome medica l history, or for patients wishing minimal risk treatment, TUR might b e a reasonable treatment modality.