Prognostic significance of non-papillary tumor morphology as a predictor of cancer progression and survival in patients with primary T1G3 bladder cancer.
OBJECTIVE
To investigate the prognostic significance of tumor morphology in relation to progression and survival in patients with primary T1G3 bladder cancer (BC) METHODS: After review of pathology, 194 patients who were diagnosed with primary T1G3 BC after clinically complete transurethral resection between 1989 and 2005 were seen. Of these patients, 144 underwent surveillance and 50 underwent immediate cystectomy. Tumor morphology (gross and microscopic) in addition to other clinicopathological factors such as tumor size, multifocality, lymphovascular invasion (LVI), carcinoma-in-situ (CIS), intravesical therapy, and the absence of proper muscle were evaluated with regard to recurrence, progression, upstaging, and survival. In addition, correlations between tumor morphology and other factors were analyzed.


RESULTS
Median follow-up was 52.5 months. Five-year cancer-specific survival rates were 92.1% for entire cohort, 95.6% for surveillance group, and 84.0% for immediate cystectomy group, respectively. During surveillance, recurrence and progression were noted in 43.1, 13.2%, respectively. Of the potential prognostic factors analyzed, non-papillary morphology (both gross and microscopic) was a significant parameter of progression and intravesical therapy was significantly predictive of recurrence. After immediate cystectomy, 34% were upstaged. Non-papillary morphology and the absence of proper muscle were related to upstaging. For entire patients, non-papillary morphology and the absence of proper muscle were also significant predictors of patient's survival (P = 0.048, HR = 4.826, and P = 0.007, HR = 5.663, respectively). Non-papillary tumors were significantly related to the presence of LVI and CIS compared to papillary tumors.


CONCLUSIONS
Non-papillary tumor morphology was a predictor of cancer progression and survival in patients with primary T1G3 BC.
Park
Jinsung
J
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap 2 Dong, Songpa-gu, Seoul, 138-736, South Korea.
Song
Cheryn
C
Hong
Jun Hyuk
JH
Park
Bong-Hee
BH
Cho
Yong Mee
YM
Kim
Choung-Soo
CS
Ahn
Hanjong
H
D000368:Aged; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology*