Invasive, high grade transitional cell carcinoma of the bladder treated with transurethral resection. A survival analysis focusing on TUR as monotherapy

Abstract

Two hundred and fifteen consecutive patients admitted to our department between 1978 and 1988 were included in a retrospective study. Entrance criteria were transitional cell carcinoma of the bladder T1-4, Grade III-IV. Status of nodes and metastases were not recorded. Initially all patients had a macroscopically radical transurethral resection (TUR). Patients were followed with cystoscopies. Recurrent tumours were treated with repeated TUR (RE-TUR). In cases of progression to a higher T-stage or recurrences with multiple papillomas (> 10), adjuvant therapy was recommended. The patients were retrospectively allocated to three different groups. Group 1 had TUR only, Group 2 had TUR + adjuvant irradiation, and Group 3 had TUR and various adjuvant therapies (Table I). Median crude actuarial overall survival was 29 months. In Groups 1, 2 and 3, median crude survival was 37, 13 and 32 months, respectively. In the analysis, most emphasis was put on Group 1. For stages T1-4 in this group, the median survivals was 67, 19, 9 and 2 months, respectively. Differences were statistically significant (p < 0.05). T1 tumour stage seemed to predict a reduced risk of progression compared with the higher tumour stages (p = 0.05, Fisher's test). There was a tendency for females to progress less often than men, but the difference was not statistically significant. In conclusion, macroscopically radical TUR does not seem to offer the same cure rates as radical cystectomy. However, in a selected group of patients with a troublesome medical history, or for patients wishing minimal risk treatment, TUR might be a reasonable treatment modality.