[Clinical course and mid- and long-term prognosis of superficial bladder tumors]

To evaluate the outcome of 551 patients with superficial transitional cell carcinomas of the bladder. To determine prognostic factors in these patients by means of the log-rank analysis of the Kaplan-Meier curves and a multivariate analysis with Cox regression model for the disease free survival (DFS), time to progression to infiltrating lesions (TTP) and overall survival (OS).

Between 1983 and 1998 we have seen 551 patients with superficial transitional cell carcinomas of the bladder in our Hospital. Fifteen patients included in this series had been diagnosed in other hospitals before 1983. The clinical records were actualized between 1998 and 2000 and only 21 patients were lost to follow-up (3.8%). The mean follow-up time was 6.2 years (median time: 5.3). One hundred and eleven patients (20%) died with a mean of 4.5 years (median time 3.4). Four hundred and forty patients were still alive on completion of the study with a mean follow-up time of 6.6 years (range 2-24 years; median 5.7).

Four hundred and fifty-nine patients were men (83%) with a mean age of 64 years and 92 were women (17%) with a mean age of 70 years. In 347 patients there was only one tumour (63%). The tumours were stage Ta in 79 cases (14%). T1 in 431 (78%) and Tis in 41 (7%). The histological grade was G1 in 406 cases (74%), G2 in 96 (17%) and G3 in 33 (6%). There were recurrences in 253 patients (46%) with a mean time of 2.2 years. The DFS was 55% at 5 years, 44% at 10 years and 38% at 15 years. The multivariate analysis has shown a negative prognostic influence on DFS of the presence of multiple tumours (RR 1.4 CI 1.19-1.69), increasing age (analysed as a continuous variable) and the sex (being worse for females; RR 1.2 CI 0.98-1.52). In 40 patients (7.3%) the tumour became infiltrative in a mean of 3.3 years. The TTP was 93% at 5 years, 91% at 10 years and 90% at 15 years. The negative prognosticators in the multivariate analysis were G3 tumour (RR: 5.1 CI 2.7-9.6), the group of tumours Ta-T1G3 or multiple T1G2 or Tis (RR 4.6 CI 2.6-7.9) and the age > 70 years (RR 2.14 CI 1.2-3.7). Thirty-one patients (5.6%) died of the tumour in a mean time of 4.6 years. The OS was 95% at 5 years, 93% at 10 years and 91% at 15 years. Significant prognosticators in the multivariate analysis for OS were the group of risk tumours Ta-T1G3 and multiple Tis or T1G2 (RR 5 CI 2.7-9) and age > 70 years (RR 4.56 CI 2.2-8.8).

The recurrence rate is very high in all the patients, but the risk is highest when the tumours are multiple. The risk of progression is low, but still exits even in patients with tumours of low malignant potential. The highest risk is associated with Ta-T1G3 of Tis or multiple T1G2.