1976 Volume 67 Issue 10 Pages 775-784
The present authors showed the 5-year survival rate of 47 of the 51 patients with bladder tumors undergoing total cystectomy (and radical total cystourethrectomy) for the past 10 years. Four of the 51 patients, comprising 3 operative deaths and 1 whose histopathological data were missing, were excluded from analysis. Years of the authors' steady improvement in the technique of suprapubic urinary diversion have made it possible to attain an actual 5-year survival rate as high as 83.1 per cent in patients with low-stage bladder carcinomas. This performance, however, applies to cases of low-stage cancer alone, and still defies the access of high-stage carcinomas.
The authors came to consider that the factors governing the prognosis of bladder tumors are not only stage and grade but macroscopic growth pattern, histopathological mode of spread of the forefront, and intramural lymphatic and venous invasion. We propose the following pathological classification of the latter four items, in view of their roles in determining the prognosis.
a. Macroscopic growth pattern: Pe, Se1, Se2, Se3
b. Histopathological mode of spread: α, β, γ from the viewpoint of INF (type of infiltration)
c. Intramural lymphatic invasion: ly0, ly1, ly2, ly3
d. Intramural venous invasion v(-) v(+)
As far as b. Histopathological mode of spread and c. Intramural lymphatic invasion are concerned, significant difference in the 5-year survival rate was detected between a and β plus γ, and ly0-1 and ly2-3.
Of the four items from a to d, the magnitude of b. Histopathological mode of spread in terms of INF is detectable to a certain extent even with the conventional TUR. Accordingly, the INF must serve as a useful guide to the early judgment of whether superficial carcinomas in question are progressive or to remain dormant, and undoubtedly lead to the establishment of policy in the management of superficial bladder carcinomas.
