title: Prognostic significance of non-papillary tumor morphology as a predictor of cancer progression and survival in patients with primary T1G3 bladder cancer.
abstract: 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.
authors.affiliation: Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap 2 Dong, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Jinsung
authors.initials: J
authors.lastname: Park
authors.forename: Cheryn
authors.initials: C
authors.lastname: Song
authors.forename: Jun Hyuk
authors.initials: JH
authors.lastname: Hong
authors.forename: Bong-Hee
authors.initials: BH
authors.lastname: Park
authors.forename: Yong Mee
authors.initials: YM
authors.lastname: Cho
authors.forename: Choung-Soo
authors.initials: CS
authors.lastname: Kim
authors.forename: Hanjong
authors.initials: H
authors.lastname: Ahn
mesh_terms: 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*