ABSTRACT
We analyzed the prognostic factors, such as sex, age, tumor shape, number, 1ocation, size, TNM stage, WHO grade, modified Bergkvist grade, treatment modality, cytology, type of progression, mitotic activity index(MAI), volume corrected mitotic index(M/V index) and pathologic grade, in a chort of 83 advanced transitional cell carcinoma of bladder who was followed for more than 3 years. N stage of TNM,WHO grade, modified Bergkvist grade and pathologic stage were related to mitotic indices(p<0.05), but cytology was related to MAI only (p<0.05).In univariate analysis of prognostic factors, sex, N and M stage of TNM, progression type, MAI & M/ V index and pathologic stage were related to 5-year survival during follow up. Multivariate analysis of prognostic factors, which were significantly related in univariate analysis, identified MAI as the most important factor(p<0.05), followed by M/V index, N stage of TNM, sex, M stage of TNM and progression type. The result show that advanced transitional cell bladder tumors can be efficiently categorized into prognostic groups by quantitative mitotic frequency analysis.
Subject(s)
Carcinoma, Transitional Cell , Follow-Up Studies , Mitotic Index , Multivariate Analysis , Prognosis , Sex Factors , Urinary Bladder Neoplasms , Urinary BladderABSTRACT
The efficacy of adjuvant chemotherapy in locally advanced bladder cancer is still debated. Between March 1986 and February 1995, we retrospectively reviewed 25 patients with invasive, pathological stage P3b, P4 or N1 and M0 transitional cell carcinoma of the bladder who were treated with radical cystectomy alone (control group), adjuvant M-VAC chemotherapy after the surgery. The mean follow up period was 28 months. There were 13 patients in the control group and 12 in adjuvant chemotherapy group. The pathological stage distributions were P3b in 9 patients (5 in control group, 4 in chemotherapy group), P4 in 9 patients (5 in control group, 4 in chemotherapy group), N1 in 7 patients (3 in control group, 4 in chemotherapy group). Median survival times were 27 months in adjuvant chemotherapy group compared to 15 months in the control group, however they were not related statistically each other (P>0.05). The 2-year survival rates were 38% in control group, 70% in adjuvant chemotherapy group but they were not related statistically each other (P>0.05). We are not able to confirm the efficacy of adjuvant M-VAC chemotherapy in locally advanced bladder cancer. However adjuvant chemotherapy seems to have some beneficial effect. Controlled prospective clinical trials with large number of patients would be needed to assess the real efficacy of adjuvant M-VAC chemotherapy.
Subject(s)
Humans , Carcinoma, Transitional Cell , Chemotherapy, Adjuvant , Cystectomy , Drug Therapy , Follow-Up Studies , Retrospective Studies , Survival Rate , Urinary Bladder Neoplasms , Urinary BladderABSTRACT
We retrospectively reviewed eleven patients with advanced bladder carcinoma (T3b-4) who were treated with methotrexate, vinblastine, doxorubicin and cisplatin (M-VAC) chemotherapy alone. 1. The mean age and the cycle were 64 years ( 50-75) and 4.7 cycles ( 1-II) respectively. 2. In primary lesions, four (36.4 per cent) showed partial response, six (54.5 per cent) minor response and one (9.1 per cent) clinically stable, and therefore response rate was 36.4 per cent. There was no case of complete remission. In extravesical lesions, progression was seen in a case of liver metastasis and no remarkable changes was seen in bone metastatic case. 3. Maximal effect of clinical response was observed after completion of 3-4 cycles in cases of partial remission. 4. There were marked improvement of clinical symptoms such as loss of hematuria and dysuria during 1 or 2 cycles of chemotherapy. Even though there was no case of complete remission in our cases, 3-4 cycles of M-VAC monotherapy may be considered as a kind of treatment of the advanced transitional cell carcinoma or bladder in selected cases.