1988 Volume 79 Issue 11 Pages 1837-1847
The reason for poor prognosis observed in squamous cell carcinoma (SCC) was analytically studied.
From 1963 to 1986, 186 patients with bladder cancer underwent total cystectomy. Nine cases had SCC, 26 had SCC mixed with transitional cell carcinoma (TCC) (mixed type), 68 had TCC of Grade 3 and 83 had TCC of Grade l and 2. These four groups were examined with regard to the clinicopathological features and prognosis.
SCC and mixed SCC and TCC groups exhibited a female predominance took the form of dominant nonpapillary sessile carcinomas and invasive carcinomas of pT3 and pT4. In these two groups, hydronephrosis and local recurrence after cystectomy were observed at a higher rate than other groups indicating that they showed a more invasive growth. It is believed that TCC develops from squamous metaplasia of the transitional epithelium. However, concomitant leukoplakia and squamous metaplasia were not disclosed on the noncancerous urothelial epithelium in the SCC group. In the mixed type, the Grade 3 TCC were most frequently combined with SCC. Five-year survival rates in increasing order were 26% in mixed type, 32% in SCC, 55%in Grade 3 TCC and 73% in Grade l and 2 TCC.
These results suggest that, at the very beginning of carcinogenesis, both SCC and mixed type carcinomas already acquired the invasive nature, having very poor prognosis. Treatment for SCC and SCC+TCC groups should be carefully planned, probably with combination of radical cystectomy and chemotherapy.
