title: A prognostic index (bladder prognostic index) for bilharzial-related invasive bladder cancer.
abstract: OBJECTIVE
  Bladder cancer is still the most common solid tumor among adult males in Egypt because of the prevalence of bilharzial infestation, especially in the countryside. In this prospective study, we have recorded the prognostic factors for 180 patients with invasive bladder cancer for whom standard radical cystectomy had been performed to develop a prognostic index (bladder prognostic index) that defines high risk patients who are more vulnerable to disease relapse after surgery and who may benefit from additional therapy.
  
  
  METHODS
  The study was performed between January 1997 and December 1999, in which 180 patients with histopathologically proved invasive bladder cancer associated with bilharziasis underwent radical cystectomy or anterior pelvic exenteration. After surgery, patients were regularly followed for a minimum of 2 years.
  
  
  RESULTS
  Our patients included 141 males and 39 females. Squamous cell carcinoma was the most common type (53.3%), and most of the tumors were grade II (61.1%). A total of 173 patients had their tumors operable, while 7 were inoperable. We had 5 (2.8%) operative related mortalities. At 5 years postoperatively, free and overall survival rates for the whole group of patients were 31.44%+/-5.9% and 32.5%+/-6.8%, respectively. Tumor pathologic stage, grade, and nodal affection were the only significant factors with impact on survival (P=0.008, 0.051, and 0.004, respectively). These 3 prognostic indexes were used to design a model to predict an individual patient's risk factor for recurrence. Patients were then assigned to one of the 4 risk groups according to the score achieved in this prognostic index (0=low risk, 1=intermediate risk, and 2 or 3=higher risk). These 4 risk groups had distinctly different rates of disease-free survival, i.e., 91.7%, 53%, 13%, and 7% for low, intermediate, and higher risk groups, respectively.
  
  
  CONCLUSIONS
  Although this prognostic index appears to be of a significant clinical relevance, it needs to be more validated on a larger number of patients, and it could be a surrogate variable for biologic factors responsible for the heterogeneity of bladder cancer.
authors: Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt. Khaled@internetegypt.com
authors: Hussein
authors: H
authors: Khaled
authors: Omar
authors: O
authors: El Hattab
authors: Doaa Abdel
authors: DA
authors: Moneim
authors: Hatem Aboul
authors: HA
authors: Kassem
authors: Ahmed
authors: A
authors: Morsi
authors: Ghada
authors: G
authors: Sherif
authors: Tarek
authors: T
authors: Darwish
authors: Rabab
authors: R
authors: Gaafar
mesh_terms: D000328:Adult; D000368:Aged; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012552:Schistosomiasis / Q000145:classification*; D016019:Survival Analysis; D001749:Urinary Bladder Neoplasms / Q000209:etiology* / Q000473:pathology* / Q000601:surgery