LONG-TERM SURVIVAL OF PATIENTS WITH BLADDER-TUMORS - THE SIGNIFICANCEOF RISK-FACTORS

Objective To evaluate the significance of known risk factors, accessib le by simple endoscopic and histological/cytological examination, on t he clinical course and long-term survival of patients with superficial urinary bladder tumours. Patients and methods The study included 584 consecutive unselected patients, primarily admitted between 1976 and 1 984 for newly diagnosed bladder tumour, which was superficial (Ta, T1, Tis) in 362. The patients were followed routinely in a control progra mme; causes of death were obtained by autopsy (44%), from hospital fil es (33%) or from death certificates (8%), the remaining patients being alive at the end of the study, up to 20 years after initial diagnosis . Known risk factors, e.g. tumour size, histological grade, multiplici ty and positive urine cytology, and dysplasia as assessed by random or pre-selected site biopsies, were evaluated as predetermining factors for new occurrences and survival. Results Invasion of the lamina propr ia was the most significant prognostic factor detected in the multivar iate analysis. While 14% of patients with Ta tumours had died from can cer after 15 years, 63% of the T1 tumours were eventually fatal, reach ing the mortality of those with T2 disease. Other independent signific ant factors were tumour size and, to a lesser extent, histological gra de. Multiplicity and concomitant epithelial changes, as assayed by voi ded urine cytology and pre-selected site biopsies, were relevant progn ostic factors for Ta but not for T1 tumours. Conclusion In the therapy and surveillance of superficial urinary bladder rumours, the presence of lamina propria invasion is very important.