[Infiltrating transitional carcinoma of the bladder. Prognostic value of anatomopathologic staging and therapeutic...

The pathologic stage of the tumor is the most reliable parameter on which to make a diagnosis in patients with infiltrating transitional cell carcinoma of the bladder. Pathologic staging classed twelve as PO, 22 as P1, 28 as P2, 63 as P3, and 36 as P4. No significant difference exists as to survivorship in patients with P0, P1, and P2 tumors. However, when the foregoing 3 groups are considered as one single group, these present a significantly higher survival rate than that observed for tumor class P3 and P4. For the group comprised of patients with tumor class P0 + P1 + P2, the highest probability of survival corresponds to the group treated with 2,000 rads, and the lowest corresponds to the group treated with 4,500 rads, although the difference observed is not significant. The treatment regimen given to patients with tumor classes P3 and P4 was observed to have scant influence on patient survival. The same findings were observed with respect to the disease free intervals. Patients with P2 tumors showed a very good course regardless of the treatment regimen they received. Thus, the bladder may be preserved in those patients with a proven P2 tumor. When the tumor has spread to perivesical fat or regional lymphatics, systemic chemotherapy is warranted. This must be instituted immediately postoperatively regardless of the loco-regional regimen chosen because micrometastases are very likely to exist.