THE VALUE OF PATHOLOGICAL FACTORS IN PREDICTING CANCER-SPECIFIC SURVIVAL AMONG PATIENTS TREATED WITH RADICAL CYSTECTOMY FOR TRANSITIONAL-CELL CARCINOMA OF THE BLADDER AND PROSTATE

Background. A recent consensus conference on bladder carcinoma highlig hted the need for pathologic predictors of outcome for patients with t ransitional cell carcinoma of the bladder. This review was undertaken to determine the pathologic features predictive of cancer-specific sur vival after a radical cystectomy and urinary diversion for transitiona l cell carcinoma of the bladder and prostate. Methods. Between 1969 an d 1990, 531 patients with transitional cell carcinoma of the bladder a nd prostate were treated with radical cystectomy at the Duke Universit y Medical Center. Records and pathologic specimens were analyzed and c orrelated with outcome. Both univariate and multivariate analyses of t he pathologic staging were performed to identify variables predictive of cancer-specific survival. Results. Univariate analysis indicated th at pathologic tumor (pT) stage, positive nodes, positive surgical marg ins, prostatic stromal involvement. grade, age, ureteral involvement, squamous cell carcinoma, and squamous cell differentiation in the spec imen all were predictive of poor cancer-specific survival. Carcinoma i n situ (CIS) in the specimen was not an adverse prognostic indicator. Multivariate analysis demonstrated that the pT stage, nodal involvemen t, positive surgical margins, patient's age at surgery, and loss of hi stologic differentiation were predictive of poor cancer-specific survi val. CIS was found again not to have a negative influence on cancer-sp ecific survival. Conclusions. If any of these features are noted in th e final pathologic specimen, patients should be considered for some fo rm of additional postoperative treatment such as chemotherapy or radia tion therapy in an attempt to improve their chances for cancer-free su rvival. These factors will become more important in selecting which pa tients should be placed in developing adjuvant clinical trials.