PROGNOSTIC FACTORS IN PT(A)-PT(1) SUPERFICIAL BLADDER-TUMORS TREATED WITH INTRAVESICAL INSTILLATIONS

Objective To identify prognostic factors that enable patients with sup erficial bladder cancer to be divided into groups who will probably re spond to therapy and those who will not. Patients and methods In a pro spective randomized study 387 patients with pT(a)-pT(1) superficial bl adder carcinoma received, after transurethral resection, intravesical instillations with immuno- or chemotherapy. A simultaneous computerize d analysis of factors predicting the recurrence-free interval was perf ormed. All these patients had negative random biopsies. Pretreatment f actors analysed for recurrence were gender, age, history (primary or r ecurrent disease), location of tumour, number of tumours, pT-stage and grade. Results Median follow-up was 27 months (range 12-56). During t he follow-up period 37.2% of the patients had recurrence and eight pat ients (2.2%) had progression into muscle invasive disease. After a uni variate analysis the number of tumours and location of the tumour in t he bladder appeared to be a significant influence on the recurrence-fr ee interval. Location of at least one of the tumours in the prostatic urethra, bladder neck, posterior wall, and trigone area was significan tly related to a shorter recurrence-free interval; these areas were de fined as high risk. Tumour stage showed borderline significance. By us ing multivariate methods to assess the relative importance of these fa ctors, location of tumour in the high risk region was related especial ly to a short recurrence-free interval. The factor found to be of sign ificance for the prognosis for recurrence was tumour multiplicity. Gen der, age, history of recurrent disease, size of the largest tumour, tu mour stage or grade gave no additional information about the risk of r ecurrence. Conclusion Prognostic factor analysis, as an auxilliary stu dy of trials of patients treated for superficial bladder tumours, is m andatory. The prognostic factors related to recurrence-free interval f ound in this study, location of the tumour and multiplicity, may be of use in the stratification necessary for current protocol design.