Prognostic factors for survival in patients with transitional cell carcinoma of the bladder: evaluation by histopathologic grade, pathologic stage and flow-cytometric analysis.

Abstract

Univariate and multivariate statistical analyses of prognostic factors were performed on 93 patients with transitional cell carcinoma of the bladder who had undergone cystectomies between 1978 and 1988. All patients underwent DNA flow cytometry by way of paraffin-embedded specimens. In univariate analysis, ploidy status, proliferation index, T stage, lymph node status and histopathologic grade were significant prognostic factors. However, in multivariate analysis, only ploidy status (p = 0.0000) and T stage (p = 0.0254) were significant as prognostic factors. With these two variables, we stratified the patients into three distinct groups with varying degrees of prognosis. The mean survival time was 91.3 months for group 1 (diploid T3a or less), 71.3 months for group 2 (diploid T3b, T4/aneuploid T3a or less) and 25.7 months for group 3 (aneuploid T3b, T4). Group 1 patients had a significantly longer survival rate than did the group 2 patients. The difference in survival between groups 2 and 3 was also statistically significant. This study shows that DNA ploidy together with T stage may be a useful prognostic factor when identifying risk groups and planning management of patients with transitional cell carcinoma of the bladder.