PROGNOSTIC FACTORS IN NODULAR TRANSITIONAL-CELL BLADDER-TUMORS

A cohort of 106 nodular transitional cell bladder cancers (TCC) were followed up for a mean of 9 years. Clinical stage, WHO grade, six morphometric nuclear factors and volume corrected mitotic index (M/V index) were correlated to progression and survival during the follow-up period. Nuclear factors were related to WHO grade with a borderline significance (p=0.01-0.3) whereas the M/V index showed a highly significant relation to WHO grade. Neither nuclear factors nor the M/V index were related significantly to T-, N- or M-categories at the time of diagnosis. Progression in N- and M-categories was related independently to WHO grade whereas progression in T-category could not be predicted significantly by none of the variables included in this analysis. Survival was predicted by T-category (p=0.0028), N-category (p=0.0001), M-category (p=0.0057) and M/V index (p=0.010). In T1-T2N0M0 tumours survival was predicted by the Dmax (p=0.015) and by the M/V index (p=0.039). In multivariate survival analysis T-category (p<0.001) had independent prognostic value. In T1-T2N0M0 tumours only the M/V index predicted survival independently (p=0.007). The results show that only the proliferation rate in addition to T-category have prognostic significance in nodular TCC.