1987 Volume 78 Issue 11 Pages 1940-1949
Histologic features of transitional cell carcinoma of the urinary bladder obtained in curative surgery in 131 patients were analyzed in relation to the patient prognosis. Histologic features involved the stage, grade, growth pattern, infiltration pattern (INF), and lymphatic (ly) and vascular (V) invasion. Survival rate was estimated by Kaplan-Meier's method and statistical difference of the prognosis was analyzed by Cox-Mantel's test.
The overall 5-year survival rate (5y-SR) of the low stage tumor (pTis-pT1b) was 71%, but its 5y-SR significantly decreased to a range of 30-50% when the tumor was G3, nonpapillary, INFβ-γ and or ly1-2. On the other hand, although 5y-SR of high stage tumor (pT2-pT4) was as low as 24%, its 5y-SR approximated to 50% when the tumor was papillary or without lymphatic invasion.
The tumor grade well reflected the malignant potential of this disease: the 5y-SRs of G1, G2 and G3 tumors were 87%, 59% and 17%, respectively, with significant differences of prognosis among them. Even in low stage, the 5y-SR of G3 tumor was 40%. In contrast to the difinitive prognostic values of G1 and G3 tumor grades, the position of G2 tumor seemed undetermined. However, the prognosis of G2 tumor was clearly differentiated when the tumor histology was classified according to the growth pattern; the 5y-SR of G2 papillary tumor was 70%, while that of G2 nonpapillary tumor was 21% (p<0.001).
The histologically defined growth pattern also exhibited the malignant potential of this tumor. The overall 5y-SR of papillary tumor was 72%, and even in high stage, its 5y-SR was over 50%. On the other hand, the 5y-SR of nonpapillary tumor was below 46% regardless of other histologic features, the overall 5y-SR of nonpapillary tumor being 19%.
The present results indicate the importance of histologic features and their relationships in better understanding of the natural history of bladder carcinoma.
