MULTIVARIATE ANALYSIS OF THE PROGNOSTIC FACTORS OF PRIMARY SUPERFICIAL BLADDER CANCER

PURPOSE To determine survival in patients with muscle-invasive bladder cancer treated with neoadjuvant chemotherapy and to analyze prechemotherapy and postchemotherapy factors for prognostic significance. PATIENTS AND METHODS The survival of 111 patients with T2-4N0M0 bladder cancer treated with neoadjuvant methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC) was assessed. Prechemotherapy and postchemotherapy factors were analyzed for correlation with survival. Factors found to be significant on univariate analysis were subjected to multivariate analysis using Cox's proportional hazards model. RESULTS The median follow-up duration was 5.3 years. Initial tumor (T) stage (P = .0001), presence of ureteral obstruction (P = .0074), and presence of a palpable mass (P = .0039) were the only pretreatment factors found to be significant on univariate analysis. Postchemotherapy surgery was performed in 81 patients. In these cases, postchemotherapy clinical stage and pathologic stage were significant factors on univariate analysis. In the multivariate analysis, the initial prechemotherapy T stage and the postchemotherapy pathologic stage (pT stage) were the only two factors to demonstrate independent significance. An association between downstaging postchemotherapy and survival was observed for patients with extravesical disease (T < or = 3B) at the start of treatment. In this subset, the 5-year survival rate was 54% for patients with downstaging versus 12% for those without downstaging. This association was not observed for patients with bladder-confined disease (T < or = 3A) at presentation. CONCLUSION The stage of bladder cancer at presentation and at postchemotherapy pathologic staging are independent prognostic factors for long-term survival in patients treated with neoadjuvant chemotherapy. Downstaging after neoadjuvant chemotherapy was associated with improved survival in patients with muscle-invasive bladder cancers, but only for those with extravesical disease (T > or = 3B) pretreatment. Randomized comparisons will be required to assess the impact of chemotherapy on overall survival.

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Prognostic Factors in Superficial Bladder Cancer

European Urology ◽

10.1159/000474811 ◽

1992 ◽

Vol 21 (2) ◽

pp. 89-97 ◽

Cited By ~ 29

Author(s):

J.A. Witjes ◽

L.A.L.M. Kiemeney ◽

G.O.N. Oosterhof ◽

F.M.J. Debruyne

Keyword(s):

Bladder Cancer ◽

Prognostic Factors ◽

Superficial Bladder Cancer

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Primary Cisplatin, Methotrexate and Vinblastine Aiming at Bladder Preservation in Invasive Bladder Cancer: Multivariate Analysis on Prognostic Factors

The Journal of Urology ◽

10.1016/s0022-5347(01)66041-5 ◽

1996 ◽

Vol 155 (6) ◽

pp. 1897-1902 ◽

Cited By ~ 35

Author(s):

Javier C. Angulo ◽

Manuel Sanchez-Chapado ◽

Jose I. Lopez ◽

Nicolas Flores

Keyword(s):

Bladder Cancer ◽

Multivariate Analysis ◽

Prognostic Factors ◽

Invasive Bladder Cancer ◽

Bladder Preservation

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Prognostic Factors in Patients Treated with Intravesical Bacillus Calmette-Guerin for Superficial Bladder Cancer

The Journal of Urology ◽

10.1016/s0022-5347(17)42723-6 ◽

1988 ◽

Vol 139 (5) ◽

pp. 941-944 ◽

Cited By ~ 67

Author(s):

Ralph J. Torrence ◽

Louis R. Kavoussi ◽

William J. Catalona ◽

Timothy L. Ratliff

Keyword(s):

Bladder Cancer ◽

Prognostic Factors ◽

Superficial Bladder Cancer ◽

Bacillus Calmette Guerin

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Upper urinary tract cancer: Prognostic factors for bladder tumours development and systemic relapse

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.14560 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 14560-14560

Author(s):

F. Merlin ◽

M. Riolfi ◽

T. Sava ◽

F. Consoli ◽

C. Griso ◽

...

Keyword(s):

Bladder Cancer ◽

Prognostic Factors ◽

Urinary Tract ◽

Vascular Invasion ◽

Superficial Bladder Cancer ◽

Transitional Cell ◽

Upper Urinary Tract ◽

Upper Tract ◽

Well Differentiated ◽

Systemic Relapse

14560 Background: Transitional cell carcinomas (TCC) of the renal pelvis and ureter are relatively uncommon. An important characteristic of TCC is multifocality throughout the all urinary tract simultaneously and/or subsequently. To clarify the association between UTTCC and bladder tumors, we retrospectively analysed 86 patients with UTTCC in order to evaluate prognostic factors for recurrence and to identify risk factors for development of bladder cancers. Methods: All 86 upper tract transitional cell carcinoma patients (pts) were treated surgically between January 1988 and July 2005. Median age was 69 years (range: 34–91). We observed a male predominance (71%) and 78% of patients were heavy smokers. Forty-five (52.3%) patients had a diagnosis of bladder transitional carcinoma. The median age of this group of patients was 70 range 40–87). In fifteen cases (17%), bladder tumour occurred first than upper tract neoplasia; in 14 patients bladder and upper tract tumours were synchronous. Results: Median survival was 97 months; 49 (57%) patients are alive and 43 are disease-free. Grading, stage T, lympho-vascular invasion and squamous differentiation were significant prognostic factors for systemic relapse (p < 0.05). Twenty-eight pts (32.5%) developed subsequent transitional bladder cancer after a median time of 12 months; multifocality of primitive tumours was significant predictive factor. Invasive UTTCC were less likely associated with bladder cancer. We observed that superficial bladder cancer developed more frequently in pts with well differentiated (G1–2) primitive cancer (90% of cases), without lympho-vascular invasion and with history of heavy smoke exposition. Conclusions: In our study, T, N and G confirmed to be the most important prognostic factors for systemic relapse. Lympho-vascular invasion highly predicts metastasis. Our analysis highlights that upper urinary tract cancers seem to have different history and different pattern of association with bladder tumours, according to specific prognostic factors. The development of recurrent superficial bladder cancer is more frequently associated with small well differentiated multifocal upper tract tumours.Therefore follow-up should be oriented according to these characteristics. No significant financial relationships to disclose.

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