Download Survival following Transurethral Resection of Bladder Carcinoma1

[CANCER RESEARCH 37, 2895-2897, August 1977]
Survival following Transurethral Resection of Bladder
Carcinoma1
Roger W. Barnes,2 Arthur L. Dick, Henry L. Hadley, and Oliver L. Johnston
Section of Urology, School of Medicine, Loma Linda University, Loma Linda 92354 (A. W. B., H. L. H., 0. L. J.), and Department of Urology, White Memorial
Medical Center, Los Angeles, California 90000 (A. L. D.)
Summary
Most low- and medium-stage (0, A, B1 and B2) and low
grade (I and II) tumors can be cured or controlled by ade
quate transurethral resection. This means wide and deep
removal of the tumor, frequent follow-up examinations, and
resection or electrocoagulation of recurrences. The 5-, 10-,
15-, and 20-year survivals of patients with low-stage and
low-grade cancers compare favorably with the survival fol
lowing more radical treatment (1 , 3-7).
Introduction
The survival of patients with bladder cancer is 1 criterion
by which the effectiveness of treatment can be judged. This
review was carried out to determine the survival of patients
treated by transurethral resection.
Materials and Methods
This report consists of data from the records of 573 pri
vate patients treated between 1931 and 1969 who either
have been followed for 5 or more years after initial treatment
or have died less than 5 years after treatment. Three
hundred seventy-seven (66%) of these had transurethral
resection of the bladder tumor with the intent of either cure
or effective control of the neoplasm. The remaining 96
(34%) are not included in this study because the transure
thral resection was done for biopsy only or for palliation
only (usually to control hemorrhage), or else open surgery
was performed. The reason the totals in all categories do
not equal 277 is that information on some patients was
missing in some categories. Patient ages ranged from 23 to
92 with a mean age of 64.
Fifty-two % of all patients had only 1 transurethral resec
tion and no recurrence in a period of 5 years or longer
(Table 1). Six % had more than 6 procedures. The largest
number of recurrences that any patient had was 32; most of
these were small tumors that were electrocoagulated in our
office as an outpatient procedure.
An estimation of the grade of the tumor was made by the
pathologist at the time the tumor was removed. All sections
that were available were reexamined at the time the study
I Presented
at the
National
Bladder
Cancer
Conference,
November
December 1, 1976, Miami Beach, Fla.
a Presenter.
To whom
requests
for
reprints
should
be addressed.
28
was made; the highest grade recorded was used in the
computation. All papillomas were recorded as Grade I.
The stage of the tumor was estimated from the gross
appearance of the tissues at the time of resection, from the
physical and laboratory examinations, and from the pathol
ogy report. It is difficult to stage accurately bladder tumors
that have been removed by transurethral resection . Stage A
in this report includes Stages 0 and A (mucosa and submu
cosa); Stage B includes Stages B, and B2 (into but not
through muscle); Stage C has invasion of penivesical tis
sues; and Stage 0 has evidence of metastases. It is probable
that many of the cases in this report are understaged, but it
is evident that the majority of these patients had compara
tively small and low-stage tumors.
Survival
Patient survival is a significant measure of the efficacy of
treatment. The 5-, 10-, 15-, and 20-year survivals of persons
in the general population age 64, which is the median age of
the patients in this report, are 87, 71 , 53, and 32%, respec
tively (2).
The stage of the disease at the time of the 1st examination
(Table 2) is the most significant factor affecting survival,
although the grade and the size of the neoplasm correlate
closely with the stage. Most Stage A tumors are small and
are low grade; most Stage B are larger and more malignant,
and those that have invaded through the bladder wall (Stage
C) and have metastasized (Stage D) are mostly large and
more malignant. As shown in Table 2, the survival (crude
survival; not corrected for expected survival) of patients
with Stage A tumors was significantly less than in the gen
eral population (p < 0.001 ). The survival of patients in whom
the stage could not be determined from the description of
the operative procedure or from the report of the patholo
gist is almost identical with that of those that were docu
Table 1
Number of endoscopic procedures
of total pa
of patients%
No.tients1194522772134512416451136103More
of proceduresNo.
to
than 6216
AUGUST 1977
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2895
R. W. Barnes et a!.
mented as Stage A. The survival of patients with low- and
medium-stage tumors (A and B) compares favorably with
the survival reported by others after more radical treatment
(3-7). There were only 6 Stage C and Stage D tumors that
were recorded as attempted cures or controls. Although 2
of 3 Stage C tumors so designated lived more than 10 years,
the number is too small to be significant.
The survival rate for patients with low-grade tumors (Ta
ble 3) was better than that for those with high-grade tumors.
Themewas 13% 15-year survival of Grade III and Grade IV
tumors. The 5-year survival (85%) of Grade I tumors is not
significantly different from that in the general population
(87%) (p > 0.05). For the longer periods of observation, the
survival is significantly lower than that in the general popu
lation.
The size of the tumor has survival matesignificance (Table
4). The smaller the tumor the better is the survival rate. The
survival rate of patients with tumors less than 1 cm is some
what better in all periods of observation than the Stage A
tumors. Themeare too few tumors in the group with tumors
larger than 6 cm for the survival percentages to be signifi
cant. Most of the large tumors were removed by open sur
gery and are not included in this study.
A combination of stage and grade (Table 5) shows many
Table 2
Survival
rates in relation
patients5
yr+A47/64StageNo.
(25)B23/75
(10)Not
“Numbers
in
(71)52/1
166/275 (62)83/225
parentheses,
yr+20
(28)5/20
(16)3/30
18 (44)34/102
(37)50/179
(33)15/66
(28)23/1
16
percentage.
Table 3
Su,viva!gradeNo.
rates in relation to
of survivals/total no. of
patientsGrade
yr+I
(29)II
(21)III
5 ym+
84/99 (85)―
48/94 (51)
(3)Not
and IV
22/81 (27)
(26)Total
known
(20)@1
yr+15
(43)9/32
(17)7/45
yr+10
(73)―21/49
(31)10/58
(23)Total
known96/136
A andB
(20)known
andnot
to stage
of sunvivals/totaIno. of
29/38 (76)
183/312(59)
10 ym+
47/85 (55)
16/60 (27)
15 yr+
26/66 (39)
10/44 (23)
12/64 (19)
16/33 (48)
91/242 (38)
20
13/45
5/24
7/52 (13)
1/31
11/28 (39)
54/190 (28)
6/23
25/123
Numbers
inparentheses,
percentage.Table
4Survival
rates
sizeNo.
in relation
patientsSize
2Oyr+<1
(29)1-3
cm
(19)3-6
cm
(14)>6
cm
(75)Not
cm
(6)a recorded
Numbers
to
of survivals/total no. of
5yr+
lOyr+
41/53 (77)― 23/44 (52)
93/147 (63)
42/116 (36)
19/45 (42)
8/35 (23)
5/9 (56)
4/9 (44)
28/51 (55)
16/46 (35)
in parentheses,
l5yr+
15/35 (43)
27/97 (28)
4/25 (16)
3/6 (50)
7/31 (23)
7/24
13/67
2/14
3/4
1/17
percentage.Table
5Survival
rates
stageNo.
in relation to grade and
patientsGrade
of survivals/total no. of
5yr+
l5yr+
AI
(18)II
26/32 (81)
16/28 (57)
6/19 (32)
2/11
(0)Ill
(0)Not
and IV
10/17 (59)
3/5 (60)
1/9 (11)
0/3 (0)
0/4 (0)
0/2 (0)
0/1
0/1
8/10 (80)
(43)Stage
4/9 (44)
3/7 (43)
3/7
3/4 (75)
9/25 (36)
9/43 (21)
2/4 (50)
2/20 (10)
5/32 (16)
1/3 (33)
2/15 (13)
3/25 (12)
1/3
2/11
0/14
2/3 (67)
1/2 (50)
1/2 (50)
0/2 (0)
known
BI
(33)II
(18)III
(0)Not
and IV
known
a Numbers
2896
2Oyr+Stage
lOyr+
in parentheses,
percentage.
CANCER RESEARCHVOL. 37
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Survival following Transurethra! Resection
more high-grade tumors in Stage B than in Stage A (43
versus 5) and, conversely, many more low-grade tumors (I
and II) in Stage A than in Stage B (49 versus 29). The best
survival rate, as would be expected, is in the Grade I Stage A
group, 81% 5-year survival, which is not significantly differ
ent from that in the general population (p > 0.05).
Acknowledgments
Datareportedin this paperwerecompiledwith the aid of the scientific
computer facility of the Loma Linda University.
References
1. Barnhouse, D. H., Reed, W. G., Johnson, S. H., Ill, Marshall, M., Jr., and
Price, S. E. , Jr. Staged Treatment of Invasive Carcinoma of Bladder.
Urology, 5: 606-609, 1975.
2. California State Life Table 1959-1961 . U. S. Department of Health, Edu
Discussion
Although transurethral resection does cure and control
some low-stage bladder cancers, others recur in a higher
stage and a higher grade. Further study is necessary to
determine which ones will progress to a higher stage and
grade. We are now continuing our retrospective study in an
effort to discover criteria that will allow us to make a more
accurate prognosis.
AUGUST 1977
cation and Welfare. Public Health Service, p. 63.
3. Evans, A. A., and Texter, J. H., Jr. Partial Cystectomyin the Treatment of
Bladder Cancer: 25-year Period. J. Urol., 114: 391-393, 1975.
4. Acid, E. C., Mount, B. M., and Sullivan, N. Preoperative Irradiation and
Radical Cystectomy for Bladder Cancer. Urology, 1: 42-45, 1973.
5. Richie, J. P., Skinner, D. G., and Kaufman, J. J. Radical Cystectomy for
Carcinoma of the Bladder: 16 Years of Experience. J. Urol., 113: 186189, 1975.
6. Schoenberg,H. W., Gregory,J. G., and Murphy, J. J. Low Mortality
Cystectomy in Bladder Cancer. J. Urol., 110: 671-674, 1973.
7. wajsman, z., Merrin, c. , Moore, A. , and Murphy, G. P. Current Results
from Treatment of Bladder Tumors with Total Cystectomy at Roswell
Park Memorial Institute. J. Urol., 113: 806—810,
1975.
2897
Downloaded from cancerres.aacrjournals.org on April 29, 2017. © 1977 American Association for Cancer Research.
Survival following Transurethral Resection of Bladder
Carcinoma
Roger W. Barnes, Arthur L. Dick, Henry L. Hadley, et al.
Cancer Res 1977;37:2895-2897.
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