Superficial bladder tumours: analysis of prognostic factors and construction of a predictive index

Abstract

predictive index (PI). The algebraic sum of the regression coefficients of the factors with independent and significant association with disease-free survival for each case represented a proportional hazard score (PHS). The PI was validated in another series of 156 patients (validation series) in whom the same regression coefficients for the same significant factors as the test series were used to categorize it into three risk groups. KaplanMeier survival curves were plotted to compare the different risk categories in both test and validation series. RESULTSThe mean ( SD , range) follow-up in the test and validation series were 58 (19, and 28.3 (14.9, 2-94) months, respectively. In the test series, tumour stage, DNA ploidy, multiplicity, history of recurrence, tumour configuration, cystoscopy result and the type of adjuvant therapy had independent significance for recurrence on multivariate analysis. For progression, the cystoscopy result, DNA ploidy and grade were the only independent and significant predictors. The ranges of PHS for the factors affecting recurrence-free and progression-free survival were 0.0-7.14 and 0.0-5.84, respectively, which were divided equally into three risk categories with significant differences on Kaplan-Meier curves and a log-rank test ( P < 0.001). The three categories in the validation series were significantly different from each other and each was comparable with that in the test series. CONCLUSIONSTumour stage, DNA ploidy, multiplicity, history of recurrence, tumour configuration and type of adjuvant therapy affected independently the rate of recurrence after resecting superficial bladder tumour. Recurrence at the 3-month cystoscopy, histological grade and DNA ploidy were the only predictors of progression to muscleinvasion. The PI dividing the patients into three risk groups with different treatment and follow-up strategies for recurrence and progression was reproducible in a validation series. KEYWORDSsuperficial bladder tumour, recurrence, progression, multivariate analysis, predictive index OBJECTIVESTo assess the prognostic factors that could be used to predict tumour recurrence and progression, and to construct and validate a predictive index.

The relationship between the systemic inflammatory response and survival in patients with transitional cell carcinoma of the urinary bladder

“…These results confirm the importance of tumour grade as a stage independent prognostic factor (Ali-El- Dein et al, 2003;Nishiyama et al, 2004) and are consistent with the work of O 'Quigley et al (1981), who reported that an elevated C-reactive protein concentration, measured by radial immunodiffusion and using the limit of sensitivity of 12 mg l À1 as a cutoff, was associated with poor survival in patients with invasive bladder cancer.…”

Surveillance of urothelial carcinoma

“…23 If further studies confirm this benefit, routine screening of high-risk populations could possibly lead to diagnosis at a lower stage. 24 Our data show that in a comparison of diagnosis years 1993-1996 and 1997-2000, 5-year survival rates for all stages of bladder, ureteral, and renal pelvis TCC-with the exception of stage I bladder TCC-did not Several studies have shown that higher tumor grade is a risk factor for lower progression-free survival, 25,26 although these studies did not address overall survival. It is possible that the small decrease in 5-year survival for stage I bladder cancer could be because of the increase in the proportion of high grade tumors, although other factors could contribute, as well.…”

Cálculo del riesgo biológico de multirrecidiva y progresión del carcinoma urotelial no músculo-invasivo mediante nuevos modelos matemáticos

“…Diversos estudios han identificado esta variable como predictora en la evolución del tumor [26]. Nuestro objetivo es establecer el pronóstico y tratamiento una vez se realiza la RTU y se dispone del estudio anatomo-patológico que siempre es previo a la cistoscopia de los tres meses tras RTU.…”