[Establishment of the prognostic evaluation system of T1G3 bladder urothelial cancer]

To formulate the systems of prognostic evaluation that allowed urologists to easily calculate a T1G3 bladder cancer patient's short- and long-term risk score of recurrence, progression and death after transurethral resection.

The 187 cases with T1G3 bladder cancer were diagnosed from January 1998 to October 2006. Clinical epidemiology study was carried out and prognosis information were collected. The expression of p53, fibroblast growth factor receptor 3 (FGFR3), E-cadherin, Ki-67 and microvesseldensity (MVD) of all patients' samples were detected using immunohistochemistry. The 18 prognostic risk factors were planed to estimate including gender, age, the time from symptom emerging to visiting doctor, hydronephrosis, operation ways, immediately intravesical instillation, drug of intravesical instillation, tumor size, number of tumors, tumor modality, cancer in situ, the first recurrence time ≤ 6 months, frequency of recurrence, p53, FGFR3, E-cadherin, Ki-67 and MVD. The risk factors were preliminary screened with Kaplan-Meier univariate analysis and then determined finally with multivariate Cox proportional hazards regression model. Based on the coefficients of the variables in the multivariate model, a weight for each level of each variable was obtained and the prognostic evaluation score of T1G3 bladder cancer was calculated.

Based on an average follow-up of 46 months, 100 cases of T1G3 bladder cancer recurred (53.5%), 61 cases progressed (32.6%) and 37 cases died (19.8%). The 1-, 2-, 3-, 5-year probability of tumor recurrence was 35.0%, 60.0%, 63.0%, 65.0%. The 1-, 2-, 3-, 5-year probability of disease progression was 12.0%, 27.0%, 34.0%, 38.0% and the 1-, 2-, 3-, 5-year probability of death was 0, 11.0%, 17.0%, 26.0% respectively. The tumor size, number of tumors, immediately intravesical instillation, the first recurrence time ≤ 6 months, p53 and FGFR3 were the risk factors of the tumor recurrence of T1G3 bladder cancer. The total recurrence risk score of each patient was calculated. According the recurrence risk score, the patients were divided into -3-6 group, 7-19 group and 20-32 group. The 1-year probability of tumor recurrence was 3%, 35%, 81% in each group and the 5-year probability of tumor recurrence was 20%, 65%, 100%. The tumor modality, cancer in situ, the first recurrence time ≤ 6 months, frequency of recurrence, p53 and E-cadherin were the risk factors of the disease progression. The total progression risk score of each patient was calculated. According the progression risk score, the patients were divided into 6-14 group, 15-23 group and 24-30 group. The 1-year probability of progression was 2%, 19%, 56% in each group and the 2-year probability was 7%, 33%, 88%.Only progression was the risk factor of death (RR = 324.70, 95%CI:9.848-10707.800) .

Based on the risk coefficient was translated into prognostic score and the tables of prognostic evaluation of T1G3 bladder cancer was founded initially, which showed the influence of each risk factor with intuitional scores. The model of prognostic evaluation of T1G3 bladder cancer could help the urologist to make decisions conveniently.