Radical cystectomy for historical and pathologic T1, N0, M0 (stage A) transitional cell cancer. Need for adjuvant...

Of 695 patients who, in a five-year period, underwent cystectomy for bladder cancer, 32 (4.6%) proved to have historical and pathologic Stage T1 (Stage A) transitional cell cancer. Of these, 23 (72%) had grade 3 disease or higher. Overall, in 17 (53%) progression developed after follow-up of greater than or equal to 5 years. Moreover, in 10 (31%) of the patients systemic progression developed during follow-up; less than 50 per cent of the patients were projected to be free of systemic progression at ten years. DNA ploidy pattern analysis did not prove helpful in predicting disease outcome. Because effective systemic chemotherapy has become available in the form of M-VAC (methotrexate, vinblastine, doxorubicin, and cisplatin), it seems justifiable that patients who are considered to be candidates for cystectomy because of high-grade, multifocal T1 transitional cell cancer of the bladder also could be candidates for effective neo-adjuvant chemotherapy, in addition to those who usually are part of these protocols--namely, those with greater than or equal to T2 disease.