Long‐term survival of patients with bladder tumours: the significance of risk factors

OBJECTIVE: To evaluate the significance of known risk factors, accessible by simple endoscopic and histological/cytological examination, on the clinical course and long-term survival of patients with superficial urinary bladder tumours. PATIENTS AND METHODS: The study included 584 consecutive unselected patients, primarily admitted between 1976 and 1984 for newly diagnosed bladder tumour, which was superficial (Ta, T1, Tis) in 362. The patients were followed routinely in a control programme; causes of death were obtained by autopsy (44%), from hospital files (33%) or from death certificates (8%), the remaining patients being alive at the end of the study, up to 20 years after initial diagnosis. Known risk factors, e.g. tumour size, histological grade, multiplicity and positive urine cytology, and dysplasia as assessed by random or pre-selected site biopsies, were evaluated as predetermining factors for new occurrences and survival. RESULTS: Invasion of the lamina propria was the most significant prognostic factor detected in the multivariate analysis. While 14% of patients with Ta tumours had died from cancer after 15 years, 63% of the T1 tumours were eventually fatal, reaching the mortality of those with T2 disease. Other independent significant factors were tumour size and, to a lesser extent, histological grade. Multiplicity and concomitant epithelial changes, as assayed by voided urine cytology and pre-selected site biopsies, were relevant prognostic factors for Ta but not for T1 tumours. CONCLUSION: In the therapy and surveillance of superficial urinary bladder tumours, the presence of lamina propria invasion is very important.