Prognostic index for primary adenocarcinoma of the urinary bladder

To determine the working independent prognostic factors and the prognostic index of adenocarcinoma of the urinary bladder. The effect of adding postoperative radiotherapy to radical cystectomy on this prognostic index was also investigated.

Two hundred and sixteen patients having adenocarcinoma of the urinary bladder were treated with radical cystectomy and pelvic lymphadenectomy with (82 patients) or without (134) postoperative radiotherapy. Postoperative radiotherapy (PORT) was given to the whole pelvis in a dose of 50 Gy/25 fractions over 5 weeks, and started 4-10 weeks after surgery.

The 5-year disease-free survival rate was 44 +/- 4% for the whole group. Postoperative radiotherapy improved the disease-free survival significantly from 33 +/- 6% for cystectomy alone Introduction to 58 +/- 6% for PORT patients (P = 0.002). The independent prognostic factors for DFS were the pathological stage, histological subtypes, nodal involvement and the addition of postoperative radiotherapy. The stratification of patients using prognostic indices according to the pathological findings produces identifiable prognostic groups. Postoperative radiotherapy improved the DFS significantly in the intermediate and high risk indices (p = 0.0004 and 0.0002 respectively).

The identified prognostic indices with their prognostic group could be used not only as a predictor of disease-free survival but also as a good predictor for the need to add adjuvant therapy in adenocarcinoma of the urinary bladder.