1986 Volume 77 Issue 2 Pages 208-219
From January 1957 to March 1984, 713 patients with bladder tumor were treated at Osaka University Hospital and the clinical statistics of the first occuring tumors were herein described. These 713 cases included 10 of adenocarcinoma of urachal origin, 41 of flat carcinoma, 7 of inverted papilloma 4 of diverticulum tumor and 4 of non-epithelial neoplasms. The results were summarized as followings:
1. Age distribution was from 14 to 88 years old with the average±standard deviation of 58.7±12.2. In female patients, the tumors were found at older ages than in male patients. The male to female ratio was 4.1:1.
2. Subjective complaints were gross hematuria, symptomatic or asymptomatic, in 88.8%, pain at micturition in 20.3%, frequency of urination in 22.2%, disturbance of urination in 6.6% and others in 4.4%.
3. Endoscopically multiple bladder tumors were observed in 42.5%. Small tumors (below 1cm in diameter) constituted 8.9%, medium sized ones (1 to 3cm) 41.7% and large mass (more than 3cm) 49.4%. Papillary tumors with stalk were found in 44.0%, papillary sessile tumors in 31.7%, non-papillary with stalk in 2.6% and non-papillary sessile ones in 21.7%. The main tumors located at lateral wall in 42.9%, trigonal area including ureteral orifice in 27.7%, posterior wall in 17.9%, vault in 6.6%, bladder neck in 3.1% and anterior wall in 2.8%.
4. Apparent metastasis at distant organs were revealed in 13 cases and lymph node involvements in 31 cases.
5. Histologically 93.6% of the tumors was transitional cell type. Adenocarcinoma and squamous cell carcinoma constituted 3.2% and 1.6%, respectively. Others included non-epithelial type and inflmmatory lesions, the latters were certainly misdiagnosed due to inadquate pathological specimens.
6. From comparative study of clinical and pathological stage, it could be said that there was a tendency of overstimation at preoperative diagnosis.
7. Between pathological stage and grade of malignancy, there was significant correlation by chi-square test.
8. Correlation of stage or grade of the tumors and chief complaints, size, multiplicity, shape and location was studied by chi-square test. With the progress of the stage or grade, the patients noticed cystitis-like symptomes, the size of the tumors increased, multiple tumors became frequent, and all these findings were statistically significant.
9. The treatments applied to the first tumors were total cystectomy for 173 cases, partial cystectomy, for 148 cases, tumor resection or mucosal denudation by cystotomy for 30 cases, transurethral resection for 259 cases and transurethral coagulation for 34 cases. In 68 cases, the treatments were non-surgical procedures. Irradiation was performed in 58 patients, as a definite treatment for the tumors in 25 cases, as preoperative irradiation in 8 cases, for prophylaxis to intravesical recurrence in 20 cases. The procedures were for the treatment of metastatic lesions in 3 cases and for postoperative prophylaxis of intrapelvic regrowth in 2 cases. Bladder instillation of cytotoxic agents was performed in 83 cases, most of them were to prevent intravesical recurrence. General administration of anti-cancer agents was also applied in 44 cases, for prevention of intravesical recurrence or distant metastasis in most of the cases, but in 12, the administration was as the main therapeutic modality.
10. The relative survival rates after the first treatments were 75.3%, 71.9%, 64.7% at 3, 5 and 10 years, respectively. These rates, of couse, depend on the character of the tumors and the treatments. Detailed description of this problem will be given elsewhere.
11. Intravesical recurrence rate after bladder sparing operation was calculated by actuarial method. The cumulative recurrence rates were 50.9% at 3 years, 61.5% at 5 years and 73.9% at 10 years, regardless of the application of intravesical instillation or external irradiation for prophylaxis.
