[Clinical evaluation of grade 3 superficial bladder cancer]

To evaluate the treatment of grade 3 superficial bladder tumor, retrospective analysis of superficial bladder tumors was performed with special references to tumor progression and prognostic factors.

From 1976 to 1994, 247 cases with pTa-pT1 superficial bladder tumor were treated. Mean duration of follow up 77.3 months. These patients were divided into pTa (196), pT1 (52), grade 1 (61), grade 2 (196) and grade 3 (62). The prognostic factors were calculated with multivariate and univariate analysis. Tumor progression was defined as muscle invasion or distant metastasis.

G3 tumor showed poor prognosis and was more frequent in tumor progression compared with G1 and G2 tumors (19.4% vs 0% and 1.6%). According to multivariate analysis, significant variables for actual survival rate were patient age and tumor grade. Tumor grade, recurrence and tumor configuration were also significant risk factor for cause-specific survival rate. By univariate analysis, patient age, tumor configuration, tumor size, multiplicity and concomitant CIS in G3 group were different from the other two G groups. In the G3 group, only recurrence was the predictable factor for progression. Analysis of prognosis and therapeutic modality revealed that G1 and G2 tumors were sufficiently controlled by endoscopic treatment. On the other hand, 21 cases (33.9%) of G3 tumor required total cystectomy after all. 11 cases of G3 group died of bladder cancer. Lymphatic involvement was detected in some cases of G3 tumor even if superficial. This factor showed a little relevance to poor prognosis of G3 tumor.

Tumor grade was thought to be the most important risk factor of superficial bladder tumor. These results suggested that total cystectomy should be considered for the treatment of superficial G3 bladder cancer when recurrence occurs or conservative treatment is though to be failed.