We assigned 91 patients with deeply invasive, pathological stage P3, P4 or N+ and Mo transitional cell carcinoma of the bladder (with or without squamous or glandular differentiation) to adjuvant chemotherapy or to observation after radical cystectomy and pelvic lymph node dissection. For most patients chemotherapy was planned as 4 courses at 28-day intervals of 100 mg./M.2 cisplatin, 60 mg./M.2 doxorubicin and 600 mg./M.2 cyclophosphamide. A significant delay was shown in the time to progression (p = 0.0010) with 70% of the patients assigned to chemotherapy free of disease at 3 years compared to 46% in the observation group. Median survival time for patients in the chemotherapy group was 4.3 years compared to 2.4 years in the observation group (p = 0.0062). In addition to treatment groups, important prognostic factors included age, gender and lymph node status. The number of involved lymph nodes was the single most important variable. We recommend adjuvant chemotherapy for patients with invasive transitional cell carcinoma after definitive surgical resection.
The classification of skin tumors as keratoacanthoma or squamous cell carcinoma may be difficult and, albeit rarely, lesions classified as keratoacanthoma do metastasize. In order to review the reproducibility of the pathologic classification, 100 keratoacanthomas and 100 squamous cell carcinomas of the skin were randomized and reclassified. In 81% of the keratoacanthomas and 86% of the squamous carcinomas the original diagnosis was confirmed. The presence or absence of 10 histologic criteria was recorded for all cases. Almost all of the confirmed keratoacanthomas had invaginating keratin‐filled craters with epidermal proliferation at the sides and the bottom of the lesion and significant atypia and mitotic activity was rare. Most of the confirmed squamous cell carcinomas showed considerable cellular anaplasia and pleomorphism and many displayed significant mitotic activity. It is concluded that a definite diagnosis of keratoacanthoma or squamous cell carcinoma can be made objectively on histologic grounds but that some tumors are atypical or borderline lesions which must be indicated in the pathologic report.
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