[Infiltrating transitional cancer of the bladder (2). Prognostic value of the stage. Its influence on the therapeutic decision)].
The only reliable sign to give a prognosis is the anatomopathological stage (P or pT) obtained from the study of the cystectomy surgical piece: partial or total. Tumourless (P0) bladders conceal the inability to reach any certainty over the tumour's inexistance. Removal should not be considered as a success but an error. The fact that no tumour is found in the removed bladder does not guarantee that the patient will not eventually die of metastasis. A pT2 stage has a better prognosis than pT3a and both evolve better that either pT3b or pT4a and, therefore, their treatment and management may be different. Clinical stage (T) is not a reliable sign: the possibilities of over and undervaluation are very high. Subtraction of P from T cannot be maintained as an adequate sign to assess the action of the adjuvant therapy to surgery and should be excluded in order to delimit the action of the neo-adjuvant chemotherapy. Also, patients with pT2 and pT3a tumours should be excluded from these protocols since the possibilities that they may be removed during the evaluation R.T.U. are high.
Escudero Barrilero
A
A
Hospital Ramón y Cajal, Servicio de Urología, Madrid.
Fernández
E
E
García Cuerpo
E
E
Lovaco
F
F
Navío
S
S
Ruiz
C
C
Serrano
A
A
D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology*; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D011379:Prognosis; D016019:Survival Analysis; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology*
Cancer transicional infiltrante de vejiga (2a Parte). Valor pronóstico del estadío. Su influencia én la decisión terapéutica.