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. 2010 Aug;51(8):525-30.
doi: 10.4111/kju.2010.51.8.525. Epub 2010 Aug 18.

Efficacy of bladder-preserving therapy for patients with t3b, t4a, and t4b transitional cell carcinoma of the bladder

Jaewoo Cheon  1 , Hyunchul Chung, Jaemann Song
Affiliations

Efficacy of bladder-preserving therapy for patients with t3b, t4a, and t4b transitional cell carcinoma of the bladder

Jaewoo Cheon et al. Korean J Urol. 2010 Aug.

Abstract

Purpose: Radical cystectomy has been the most widely used method in the treatment of bladder cancer, but it is limited by major problems. Therefore, we investigated the results of bladder-preserving treatment in patients with T3b, T4a, and T4b transitional carcinoma of the bladder who underwent transurethral resection of bladder cancer and subsequent administration of chemotherapy.

Materials and methods: Of all patients who were diagnosed with bladder cancer and underwent bladder-preserving treatment between January 2001 and August 2008, 78 patients with at least 12 months of follow-up data were enrolled in this study. All patients received gemcitabine (1,000 mg/m(2)) and cisplatin (70 mg/m(2)) once per month postoperatively for a total of 6 months and completed a follow-up visit every 3 months. The patient survival rate and prognostic factors (age, tumor size, differentiation, number of lesions, stage, and presence of hydronephrosis) were assessed. The Kaplan-Meier method was used to analyze survival rate, and Cox multiple regression analysis was used for prognostic factors.

Results: The mean patient age was 68.32+/-8.6 years, the mean duration of follow-up was 54.70+/-32.8 months, and the median duration of follow-up was 49.0 months. The 5-year survival rate was 66.2%. Single lesions were found in 28 cases (35.9%), and multiple lesions were found in 50 cases (64.1%). Stage T3b lesions were identified in 56 cases (71.8%), stage T4a lesions were identified in 16 cases (20.5%), and stage T4b lesions were identified in 6 cases (7.7%). Tumor size was less than 4 cm in 4 cases (59.0%) and greater than 4 cm in 32 (41.0%). Hydronephrosis was present in 21 cases (26.9%). In the 5-year survival analysis, prognostic factors significantly influencing survival rate were T-stage of the tumor and absence of hydronephrosis and complete regression after treatment (p<0.05). Multivariate analysis revealed that tumor stage and the absence of hydronephrosis were statistically significant prognostic indicators.

Conclusions: In patients with T3b, T4a, and T4b transitional carcinoma of the bladder, bladder preservation may prevent a decrease in quality of life. Also, our findings suggest that this approach could be considered a primary treatment option for patients with T3b stage tumors without evidence of hydronephrosis.

Keywords: Drug therapy; Therapeutics; Urinary bladder neoplasms.

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Conflict of interest statement

The authors have nothing to disclose.

Figures

FIG. 1
FIG. 1
Cumulative survival rate.
FIG. 2
FIG. 2
Cumulative survival rate according to tumor stage.
FIG. 3
FIG. 3
Cumulative survival rate according to hydronephrosis.
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