Survival after primary and deferred cystectomy for stage T1 transitional cell carcinoma of the bladder

The optimal time of cystectomy for nonmuscle invasive bladder cancer [NMIBC] is controversial. This study aims at comparing cancer-specific survival in primary versus deferred cystectomy for T1 bladder cancer. Between 1990 and 2004, a retrospective cohort of 204 patients was studied. Primary cystectomy at the diagnosis of NMIBC was performed in 134 patients [group 1] and deferred cystectomy was done after failed conservative treatment in 70 [group 2] Both groups were compared regarding patient and tumor characteristics and cancer-specific survival. Cancer-specific survival was calculated using the Kaplan-Meier method. Mean follow-up was 79 and 66 months, respectively, in the two groups. Tumor multiplicity was more frequent in group 2; otherwise, both groups were comparable in all characteristics. The definitive stage was T1 in all patients. Although the 3-year [84% in group 1 vs. 79% in group 2], 5-year [78% vs. 71%] and 10-year [69% vs. 64%] cancer-specific survival rates were lower in the deferred cystectomy group, the difference was not statistically significant. In group 2, survival was significantly lower in cases undergoing more than three transurethral resections of bladder tumors [TURBT] than in cases with fewer TURBTs. Cancer-specific survival is statistically comparable for primary and deferred cystectomy in T1 bladder cancer, although there is a non-significant difference in favor of primary cystectomy. In the deferred cystectomy group, the number of TURBTs beyond three is associated with lower survival. Conservative treatment should be adopted for most cases in this category

Prognostic factors in primary non-urachal adenocarcinoma of the urinary bladder: a clinical, histopathologic and flow cytometric study

Flow cytometric DNA analysis was carried out retrospectively on paraffin-embedded archival material of 93 primary pure non-urachal adenocarcinomas of the urinary bladder treated between 1981 and 1990. Tumors were classified according to histopathologic grade, stage, nodal pathology and flow cytometric DNA ploidy pattern and fraction of cells in the S-phase. The incidence of grossly aneuploid tumors was 88%. Mean follow up was 24.1 +/- 21.5 months. The crude overall survival was 62% and 50% at 2 and 5 years, respectively. Prognosis had significant correlation with tumor stage, grade and nodal pathology. The DNA ploidy pattern and fraction of cells in S-phase had no relation to stage, grade or prognosis. The results demonstrated that the DNA ploidy pattern and fraction of cells in S- phase are not prognostic parameters in non-urachal adenocarcinoma of the bladder due to the very high incidence of aneuploidy

clinical significance of nuclear bone imaging in carcinoma of the bilharzial bladder

Bone scans utilizing 99m technetium dicarboxypropane diphosphate were carried out in 445 patients with histologically proven bladder carcinoma. Osseous metastases were detected in 8.3% [37/445] of cases. Hot areas in bone scans were single in 20 patients and multiple in 17. The commonest sites were the pelvic bones and lumbar spines. Abnormal bone radio graphs were detected in 18 patients. Serum alkaline phosphatase was elevated in 30 cases and hypercalcemia was seen in 6 cases with bony metastases. Squamous cell carcinomas had shown osseous metastases in 4.7% [12/257] of cases whereas metastases were detected in. 15.3% [22/144] of transitional cell tumours and in 73% [3/41] of adenocarcinomas. Higher incidences of osseous metastases were observed with increasing clinical stage and histologic grade of the primary bladder tumours. Excluding patients with distant metastases renders local control as the most important factor in determining disease outcome in patients with carcinoma of bilharzial bladder