[Surveillance and prognosis of "Ta" superficial tumors of the bladder. Homogeneous series of 138 cases followed for 1 to 18 years]

Abstract

Objective: To identify prognostic factors (risk of recurrence and risk of progression) and define the rules for the surveillance of stage Ta superficial bladder cancers, based on the follow-up of a homogeneous patient series.

Material and method: 138 Ta bladder cancers were recruited from 1975 to 1995 and regularly followed by the same urologist. The follow-up was 1 to 18 years with a mean of 66 months and a median of 60 months.

Results: 30% of patients developed no recurrence (mean follow-up: 52 months). 70% developed one or several recurrences (mean follow-up: 80 months): 46% of Ta recurrences without progression and 24% of T > or = 1, with 10% of T > 1 recurrencesed. 13/138 patients died from bladder cancer, including 11 patients in less than 10 years. The risk of recurrence and the risk of progression were significantly correlated with: the macroscopic appearance of the cancer: size, number and extent of implantations, sessile or pedunculated nature, its site: slightly more serious on the fixed part of the organ, its clinical course assessed over the first 12 months: in patients without recurrence at 12 months: the risk of recurrence decreased from 70% to 35% the risk of deterioration decreased from 24% to 10%. However, this risk persisted in the long term: after more than 5 years without recurrence, 2 patients developed fatal recurrences, 11 and 15 years after the initial treatment.

Conclusion: Although superficial, Ta bladder cancers are serious cancers. The risk of recurrence and progression justify close surveillance in the year following diagnosis. Subsequently, the frequency of follow-up can be adapted to the specific course of each case, but, regardless of these modalities, long-term (indefinite?) surveillance is recommended.