Multivariate analysis of the prognostic factors of primary superficial bladder cancer

Purpose: We evaluate the prognostic factors of recurrence, progression and disease specific mortality in patients with primary superficial Ta and T1 t ransitional cell carcinoma of the bladder. Materials and Methods: We studied a cohort of 1,529 patients with primary s uperficial transitional cell carcinoma of the bladder treated with transure thral resection and random bladder biopsies. Mean followup was 4.2 years. S tatistical analysis was performed using the Kaplan-Meier method and multiva riate analysis was done with the Cox proportional hazards model with stepwi se forward selection. All p values were 2-sided, with odds ratios and 95% c onfidence intervals. Results: Multiple tumors (odds ratio 2), tumor greater than 3 cm. (1.65) an d carcinoma in situ (1.6) increased, whereas intravesical bacillus Calmette -Guerin (BCG) instillations (0.39) decreased the risk of recurrence. Grade 3 disease (odds ratio 19.9), multiple tumors (1.9), tumor greater than 3 cm . (1.7) and carcinoma in situ (2.1) increased, whereas BCG (0.3) decreased the risk of progression. Grade 3 disease (odds ratio 14) and carcinoma in s itu (odds ratio 3) increased the risk of disease specific mortality. Conclusions: Neither tumor stage nor dysplasia influenced tumor evolution. Multiple tumors, tumor greater than 3 cm. and intravesical BCG instillation s were risk factors of recurrence and progression. Carcinoma in situ influe nced recurrence, progression and disease specific mortality. Finally, the m ain predictor of progression and mortality was grade 3 disease.