The Natural History of Papillary Transitional Cell Carcinoma of the Bladder and its Treatment in an Unselected Population on the Basis of Histologic Grading

Abstract

Between 1950 and 1965, 365 patients were treated for transitional cancer of the bladder at our hospitals. A retrospective study was done, using clinical records and a histopathologic review to determine the long-term natural history of this population when treated conservatively. The natural history of 3 separate patient populations was discovered, based solely on the grading of the transurethrally resected fragments. Based on the grade on initial presentation these patients were divided into grades I, II and III. Of the patients 5 per cent in grade I, 16 per cent in grade II, 28 to 35 per cent in grade III not involving muscle and 83 per cent in grade III involving muscle died of bladder cancer. Ninety-seven patients (26 per cent) died of bladder cancer, 110 (31 per cent) died of other causes and 158 (43 per cent) have been alive more than 5 years (104 more than 10 years). Grade I tumors that progressed to a higher grade did so within 2 years of the initial diagnosis. Of the bladder cancer deaths 83 per cent occurred within 2 years of the initial diagnosis. Of 64 patients dying more than 5 years after presentation only 7 died of bladder cancer.

Intravesical Bacillus Calmette-Guérin Prophylactic Treatment for Superficial Bladder Tumors: Results of a Controlled Prospective Study

“…In this prospective trial, the observation of the control group has confirmed the high recurrence rate of superfi cial bladder tumors, with at least 20% chance of progres sion of the recurrent cancer [18][19][20], This study has also confirmed previous reports indicating that intravesical BCG therapy alters favorably the pattern of tumor recur rence in a significant percentage of patients with superfi cial bladder carcinoma [7][8][9][10][11][12][13][14][15][16][17], Sixty-seven percent of the patients in the BCG group were free of tumor recur rences for a mean follow-up of approximately 29 months, compared to only 42% of the control patients for almost the same follow-up period. Likewise, the mean times to tumor recurrences and the rates of tumor recurrences per 100 patient months were 13.36 versus 9.94 months and 1.69 versus 4.41 recurrences, respec tively (p < 0.05).…”

Papillary urothelial neoplasms of low malignant potential

“…15 Nine patients (5%) died of bladder cancer among 155 patients with Grade 1 urothelial carcinoma. 16 Mufti et al 23 reviewed 198 patients with Grade 1 urothelial carcinoma and found that only 53% of patients remained cancer free at 5 years; the actuarial cancer mortality rate was 4%.…”

Human bladder cancer invasion model using rat bladder in vitro and its use to test mechanisms and therapeutic inhibitors of invasion

“…Three quarters of all cases present as superficial disease and whilst half of these cases are cured by simple treatment, about half will develop recurrences (Gilbert et al, 1978). The field change theory of recurrence proposes that each recurrence has arisen de novo from a generalized precancerous urothelium (Raghavan et al, 1990;Harris and Neal, 1992).…”