[Studies on multiple mucosal biopsy in patients with bladder cancer. 2. Evaluation on the relationship between the results of multiple mucosal biopsy and recurrence, and the clinical course of cases with carcinoma in situ and micro-invasion of carcinoma in situ]

Abstract

The predictive value of grade, number of tumor and histology of mucosal biopsy for tumor recurrence, the course of carcinoma in situ and microinvasion of carcinoma in situ were examined. The Kaplan-Meier's method was used for the estimation of the recurrence-free rate in the patients who had undergone transurethral resection (TUR) and the logrank test for testing the significance of difference in recurrence-free rate. The 5-year recurrence-free rate was 32.2%. The recurrence-free rate was 51.0% after 40 months postoperatively in patients with a single tumor, 12.8% after 42 months postoperatively in those with multiple tumors. The patients with a single tumor had a significantly higher recurrence-free rate than those with multiple tumors (P less than 0.001). The recurrence-free rate was analyzed according to the grade of main tumor, but significantly difference was not present. The recurrence-free rate was 44.4% after 42 months postoperatively in patients with normal histology of mucosal biopsy and 9.5% after 34 months postoperatively in those with abnormal histology. The patients showing normal histology in mucosal biopsy had a significantly higher recurrence-free rate than those with abnormal findings (P less than 0.001). the recurrence-free rate at the same area of biopsy site was analyzed according to the histologies of 537 mucosal biopsies. The recurrence-free rate was 76.7% after 42 months post operatively in areas with a normal biopsy, 44.3% after 35 months postoperatively in those with abnormal histology and the difference was statistically significant (P less than 0.001). Of the 15 patients found to have carcinoma in situ, 4 were primary carcinoma in situ, 6 were associated with superficial papillary tumors and 5 were associated with invasive tumors. Thirteen of the 15 patients were alive and free of disease 18 to 42 months later. Two patients associated with invasive tumor died 5 and 18 months after transcatheter embolization of internal iliac arteries. Of the 13 patients who were found to have microinvasion of carcinoma in situ, 4 were not associated with visible tumor, 6 were associated with superficial papillary tumor and 3 were associated with invasive tumors. Nine of the 13 patients are alive and free of disease 7 to 53 months later. A patient without any visible tumor who was treated with TUR and intravesical chemotherapy died and three patients with invasive tumor died irrespective of the mode of treatment.(ABSTRACT TRUNCATED AT 400 WORDS)