Prognosis of Transitional Cell Bladder Cancer: A Multivariate Prognostic Score for Improved Prediction

Abstract

Clinical and histological prognostic factors were evaluated by means of Cox's analysis in 265 bladder cancer patients with a mean followup of 10 years. The parameters studied were obtained from the primary biopsies, which included clinical stage, World Health Organization grade, papillary status, morphometrically measured mean nuclear area, standard deviation of nuclear area, mean nuclear area of the 10 largest nuclei, mitotic activity index and volume corrected mitotic index. In univariate survival analysis all of the parameters predicted survival (p less than 0.001). In Cox's analysis the clinical stage was the most important prognosticator (p less than 0.001) followed by papillary status (p less than 0.001), volume corrected mitotic index (p = 0.011) and nuclear area of the 10 largest nuclei (p = 0.091). In stages Ta to T2, grades 1 to 2 tumors the papillary status (p = 0.001), mitotic activity index (p = 0.021) and T category (p = 0.029) showed independent prognostic value. Among the stages Ta to T1 tumors the papillary status included all of the available prognostic information (p = 0.001). In a separate analysis of histological features in all papillary tumors histological grade (p less than 0.001) and mitotic activity index (p = 0.021) were related independently to survival in Cox's analysis. In papillary stages Ta to T2, grades 1 to 2 tumors (mitotic activity index, p = 0.029) and in papillary stages Ta to T1 tumors (volume corrected mitotic index, p = 0.054) mitotic indexes showed independent prognostic value. In grade 2 tumors the papillary status p = 0.004) and mitotic activity index (p = 0.090) had independent prognostic value. The mitotic indexes predicted progression among stages Ta to T1 tumors (p less than 0.001) and within World Health Organization grades significantly. The combination of prognostic parameters into prognostic scores gave a more accurate estimate of survival than the single parameter approach. The results suggest morphometric grading of bladder tumors. However, papillary and nonpapillary tumors require different grade limits.

Multivariate analysis of survival, recurrence, progression and development of mestastasis in T1 and T2a transitional cell bladder carcinoma

“…In our study, the grade does not appear as an independent prognosis variable. In this aspect, our results are consistent with those included in other multivariate studies, in terms of survival, 6,12,19,21 recurrence, 8,11,[15][16][17][18][19]25 and progression. [21][22][23]25 Our study shows that there are several significant variables in the prognosis of bladder TCC at T1 and T2a classifications.…”

“…Lipponen et al 12 analyze a sample of Ta-T4 tumors and reach the conclusion that the T classification is an independent variable of cancer-related survival in the Ta-T2 tumor subgroup. They also conclude that the T classification is the most important factor of prognosis in predicting survival.…”

Cell proliferation of transitional cell bladder tumours determined by PCNA/cyclin immunostaining and its prognostic value

“…observation period is 10.2 (0.3) years (range 5-25 (Lipponen et al, 1991b,c,d) because of insufficient biopsy specimens for immunohistochemistry. The treatment and follow-up investigators were done according to standard practice (Zingg & Wallace, 1985) and the treatment of patients has been detailed previously (Lipponen et al, 1990b(Lipponen et al, , 1991b UICC 1978(UICC, 1978 and it was based on the above mentioned examinations added with the pathologists reports. The follow-up investigations were done at 3 month intervals during the first 2 years and thereafter at 6 months intervals.…”

“…In survival analysis the fraction of PCNA/ cyclin positive nuclei predicted survival in the entire cohort (P< 0.001) and in Ta-TI tumours (P = 0.0005). In a multivariate survival analysis the fraction of PCNA/cyclin positive nuclei showed independent predictive value in the entire cohort (P = 0.046), in papillary tumours (P= 0.006) Wallace, 1985) and the treatment of patients has been detailed previously (Lipponen et al, 1990b(Lipponen et al, , 1991b UICC 1978 (UICC, 1978 and it was based on the above mentioned examinations added with the pathologists reports. The follow-up investigations were done at 3 month intervals during the first 2 years and thereafter at 6 months intervals.…”

The role of the activated form of matrix metalloproteinase‐2 in urothelial cancer

“…In urothelial cancer, tumour cell in®ltration into muscle layers, surrounding tissue or vessels is associated with local recurrence, metastasis and a poor outcome [10]. However, little is known about the association between activated MMP-2 and either tumour invasion or patient outcome in urothelial cancer.…”