Survival as a function of clinical and surgical tumour stage at cystectomy in transitional cell bladder carcinoma. a long-term follow-up of 276 consecutive patients

H. Wijkstrom, U. Norming, M. Lagerqvist, B. Nilsson, I. Naslund, P. Wiklund

Research output: Contribution to journalArticlepeer-review


Introduction: The outcome of treatment for bladder cancer mainly depends on the local and systemic extent of disease. Using the TNM system, bladder tumours are incorrectly staged in 50%-50% of patients. However, as modern imaging methods have failed to improve the pre-treatment assessment of tumour stage, and the surgical stage by definition cannot be obtained before cystectomy, therapeutic decisions still rely on clinical staging. This work attempts to evaluate retrospectively the clinical staging in a consecutive series of patients selected for cystectomy and to define its limitations with a view to possible improvement. Patients and methods: From 1979 to 1988, 276 patients with newly detected or recurring TCC of the bladder were offered preoperative irradiation (20 Gy) and cystectomy. Follow-up was conducted through 1995 nnd the outcome related to both clinical and surgical data. Survival was analysed on the basis of 'intentionto-treat'. Estimates of survival probabilities were calculated by the method of Kaplan and Meier. Differences in survival among subgroups were assessed using the log-rank test and Cox stepwise regression analysis. Results: Cancer-specific actuarial survival for the whole series was 68% at 5 years and 63% at 10 years. Survival was closely related to the depth of invasion found at surgery, clearly discriminating those with tumours confined to the bladder wall (≤ P3A) from those with extravesical extension (≥ P3B). The cancer-specific survival for patients with ≤ P3A tumours was 85% and was 50% for those with ≥ P3B tumours at 5 years. This important distinction was anticipated accurately using bimanual palpation before surgery, those patients with no palpable mass after TURBT having an actuarial survival of 83% and those with a residual mass a survival of 50% at 5 years. In the multivariate analysis, increasing clinical stage was the only pre-treatment variable with significant prognostic value for survival. However, this variable was highly dependent on the palpatory findings after TURBT, the presence of a residual mass being a prerequisite for the clinical stage T3 in muscle-invasive tumour. Conclusion: Bimanual palpation is crucially important in clinical staging and there is a need for further standardization and refinement of this procedure.

Original languageEnglish
Pages (from-to)45-46
Number of pages2
JournalBritish Journal of Urology
Issue numberSUPPL. 4
StatePublished - 1997
Externally publishedYes


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