A CLINICO-PATHOLOGIAL STUDY OF 181 CASES WITH PRIMARY BLADDER TUMOR

Abstract

During the 11 years from 1971 to 1981, 181 patients with primary bladder tumor were treated in the Department of Urology, Iwate Medical University Hospital. Of these patients, 137 were males and 44 were females, with a male to female ratio of 3.1 to 1. The age distribution ranged from 20 to 84 years. The average age was 61.7 years; 62.1 in male and 60.7 in female.
From the clinical and the patho-histological study, the following results have been obtained. The clinicopathological study was done according to the General Rule for Clinical and Pathological Studies on Bladder Cancer.
1. The initial symptoms were asymptomatic hematuria in 71.2%, symptomatic hematuria in 15.5% and vesical irritability with no hematuria in 13.3%.
2. By cystoscopic observation, papillary-pedunculated tumors were found in 50.8%, papillary broad-based tumors in 14.4% and nonpapillary broad-based tumors in 33.7%. The tumors were located in the lateral wall in 50.3% of the cases, in the posterior wall in 24.3% and in the trigonum in 4.4%.
3. Histological classification, grading and staging.
i) Histological examination revealed TCC in 157 cases (86.7%), AC in 9 cases (5.0%), SCC in 7 cases (3.9%), UC in 2 cases (1.1%) and mixed type in 6 cases (3.3%).
ii) Of the cases with TCC, none was classified as Grade 0, 8 cases (5.1%) as Grade 1, 54 (34.4%) as Grade 2 and 87(55.4%) as Grade 3.
iii) As to the staging of tumor infiltration, 93 cases (51.4%) were in Stage pTa to pT1 and 67 cases (37.0%) in Stage pT2 to pT4.
iv) Intravascular invasion was found in 40 cases; lymphatic invasion in 39 and intravenous invasion in 15. Intravascular invasion was found in cases revealing more advanced invasion than Stage pT3, and in 80% of cases of Stage pT4. Intravascular invasion was found more often (in 72.7%) in cases with carcinomas other than TCC.
4. Treatments. TUR-Bt was done on 62 cases, SVR-SR on 34, TC on 64, and 21 cases received no surgical treatment. Early complications occurred in 39 (60.9%) of the cases treated by TC, and 13 of them died of early complications.
5. Prognosis. The 5-year survival rate was estimated in relation to the histological types, the grades, the stages and the surgical methods.
i) The total rate was 49.0%.
ii) Of the cases with TCC, the rate was 82.4% in Grade 1 and 81.2% in Grade 2. It was 33.9% in Grade 3, and 5.3% in the cases with carcinomas other than TCC. Together with carcinomas other than TCC, Grade 3 of TCC is grouped as the high grade group in the following descriptions, for both Grade 3 of TCC and carcinomas other than TCC showed a poor prognosis.
iii) The rate was 71.2% in Stage pTa to pT1 and 16.0% in Stage pT2 to pT4.
iv) The rate was 62.6% in cases with no intravascular invasion, and 5.1% in cases with in-travascular invasion.
v) The rate was 77.7% in cases treated by TUR-Bt. As for the stages and grades, there was 90.9% in Stage pTa to pT1 and 0% in the total of Stages pT2, pT3, and pT4, 93.7% in the low grade (Grades 1 and 2) group, and 30.1% in the high grade group.
vi) The rate was 63.0% in cases treated by SVR-SR, 88.1% in Stage pTa to pT1, 11.6% in the total of Stages pT2, pT3 and pT4, 85.9% in the low grade group and 51.3% in the high grade group.
vii) The rate was 24.2% in cases with TC, 48.5% in Stage pTa to pT1, 12.9% in the total of Stages pT2, pT3 and pT4, 30.3% in the low grade group, 33.5% in the cases with Grade 3 to TCC and 6.5% in cases with carcinomas other than TCC.