Prediction of T1-2 GI-II transitional cell bladder cancer; evaluation by histoquantitative methods

A retrospective clinicopathological study was done including 175 T1-2 GI-II bladder cancer patients who all had transurethral resection or electrocoagulation as their initial treatment. Using interactive morphometry mean nuclear area (NA), mean standard deviation of nuclear area (SDNA) and the mean area of the 10 largest nuclei (NA10) were measured in the biopsies from primary tumours. The volume corrected mitotic index (M/V index) was estimated in the same sections. The histological grading was done according to WHO and clinical staging according to UICC. Progression in bladder cancer was observed in 36 cases. The progression (T-category) was related to M/V index (p = 0.0039), non-papillar growth (p = 0.0249), histological grade (p = 0.0736) and SDNA (p = 0.1535) in that order. In a separate analysis of papillary tumours NA10 showed predictive value (p = 0.0805) in addition to M/V index (p = 0.0067). Twenty-one patients died of bladder cancer and NA (p = 0.0069) as well as M/V index (p = 0.0984) predicted survival whereas other parameters had no substantial prognostic value. In a separate analysis of papillary tumours NA (p = 0.0209) and M/V index (p = 0.0402) predicted survival. The recurrence rate or recurrence-free period could not be significantly related to histological parameters. The results suggest the use of these morphometric features in place for histological grading in prediction of T1-T2 bladder tumours. In addition the results suggest the use of more aggressive therapy and more intensive follow-up programs for rapidly proliferating tumours as expressed by high mitotic activity.