INVASION DEPTH IS THE MOST IMPORTANT PROGNOSTIC FACTOR FOR TRANSITIONAL-CELL CARCINOMA IN A PROSPECTIVE TRIAL OF RADICAL CYSTECTOMY AND ADJUVANT CHEMOTHERAPY

The aim of this prospective study was to examine the prognostic pathom orphological factors in urothelial cancer of the urinary bladder. Clin ical and morphological variables were evaluated by univariate and mult ivariate analysis in 70 patients with invasive transitional-cell carci noma of the bladder (pT1-pT4a). The patients were treated according to a prospective program consisting of radical cystectomy and pelvic-nod e dissection, either alone or followed by adjuvant cisplatinum chemoth erapy. Nodal status was pN(0) in 89% of the patients. The median follo w-up time was 5.75 years and the 5-year survival was 58%. Among the mo rphologic variables, deep invasion of the bladder wall and squamous di fferentiation indicated a poorer prognosis. Differentiation grade, pat tern of growth (infiltrating versus expanding), angioinvasive growth, glandular differentiation and concomitant prostate carcinoma (pT(1)) w ere not significative factors for survival. By contrast, a significant reduction in mortality rate was found in patients with concomitant ca rcinoma in situ. Multivariate analysis confirmed that depth of invasio n is an independent prognostic factor of outcome. The results confirm the primary importance of tumor stage in the prediction of survival af ter radical cystectomy. (C) 1994 Wiley-Liss, Inc.