MULTIPLE FREQUENT RECURRENCES IN SUPERFICIAL TRANSITIONAL-CELL CARCINOMA OF THE BLADDER - IS SURVIVAL COMPROMISED BY A CONSERVATIVE MANAGEMENT STRATEGY
D. Hrouda et al., MULTIPLE FREQUENT RECURRENCES IN SUPERFICIAL TRANSITIONAL-CELL CARCINOMA OF THE BLADDER - IS SURVIVAL COMPROMISED BY A CONSERVATIVE MANAGEMENT STRATEGY, British Journal of Urology, 79(5), 1997, pp. 726-730
Objective To examine whether a strategy of bladder conservation is rea
sonable in patients with multiple frequent superficial recurrences of
transitional cell carcinoma (TCC) of the bladder. Patients and methods
Fifty-four patients with pTa/pT1, G1/G2 tumours at diagnosis, with fi
ve or more recurrences at two or more cystoscopies within 2 years of d
iagnosis and a minimum follow-up of 4 years were identified. The patie
nts were categorized according to outcome, i.e. disease settled, conti
nuing high-activity disease and disease progression. Results Forty-fou
r patients did not progress, of whom 16 continued to have high-activit
y disease and 28 settled to a lower disease activity. One patient had
a cystectomy for superficial disease. Nine patients progressed, six wi
th muscle invasion in the bladder and three elsewhere in the urinary t
ract. Neither grade nor stage were predictive of recurrence. All but o
ne of the patients with progression had both multicentric tumours at d
iagnosis and a positive cystoscopy at 3 months. Three patients died fr
om their bladder cancer. Conclusion A policy of endoscopic resections
and intravesical chemotherapy or bacille-Calmette-Guerin, with cystect
omy reserved until muscle-invasive disease develops, does not signific
antly compromise survival in patients with high-activity superficial T
CC. Cystectomy for superficial disease is rarely necessary.