1984 Volume 75 Issue 9 Pages 1430-1436
Eighty-one patients with superficial papillary tumors of the urinary bladder were studied as to the presence of the ABH (O) cell surface isoantigens by specific red cell adherence test. Patients with blood group 0 were excluded from this study. The red blood cell adherence to more than 25% of the epithelium was defined as positive. The isoantigens on the cell surface of the bladder tumors tended to delete as the histologic anaplasia of the tumor progressed. Of 40 patients with grade 1 tumor, 25 (63%) had ABH (O) cell surface isoantigens. On the contrary, of 30 patients with grade 2 and 11 with grade 3, only 12 (40%) and 2 (18%) retained isoantigens respectively. (G1 vs. G3: p<0.05)
In 60 patients who underwent conservative procedures (TUR or transvesical tumor resection) for primary tumors, the relation of the deletion of the isoantigens to the recurrence rate of tumors was studied with intervention of the histologic anaplasia, and the numbers of tumors.
In patients with low grade tumors (grade 0 and 1) the tumor recurred in 21% (5/24) when isoantigens were retained, but in 100% (9/9) when they were not (p<0.005). On the other hand, in patients with high grade tumors (grade 2 and 3) the high recurrence rate was observed regardless of the results of SRCA test: 55% (6/11) in positive cases and 75% (12/16) in negative cases (p>0.25).
In patients who initially presented with a single tumor, the tumor recurred in 15% of patients (4/26) when isoantigens were retained. Otherwise it recurred in 82% (9/11) when they were not (p<0.005). However, in patients with multiple tumors, 78% (7/9) showed recurrence when isoantigens were retained and 86% (12/14) when they were not (p<0.5).
In view of the above results, SRCA test was considered to be useful in predicting the recurrence of tumors in patients with a low grade or a single tumor. It may have been due to the frequent coincidence of microscopic lesions such as carcinoma in situ and dysplasia which could not be found cystoscopically that the recurrence rate was higher in patients with high grade or multiple tumors regardless of the results of SRCA test.
The relation of the deletion of isoantigens to the later development of invasive cancer could not be analysed in our series because only a few patients showed malignant progression.
