The prognostic irnportance of the morphological su bdivision of the grade II superficial bladder cancer

Abstract

In this study a morphological subdivision of grade (g)ll superficial bladder cancer is proposed and correlated with recurrence and progression rate. Forty patients, 33 males and 7 females, of 70 years mean age, with initial gII superficial transitional bladder cancer were treated with transurethral resection between January and December 1987 with followup for a mean period of 4 years. Recurrences were observed in 24 patients. All histological specimens were reviewed and reclassified to gIIa and gIIb mainly according to the variation in nuclear size. the degree of nuclear atypia and the number of mitoses. 42.1 % (8119) of the gIIa and 76.2% (16121) of the gIIb tumors recurred. The observed difference in recurrence rate was statistically significant (s.s) - p< 0.05. The disease-free interval after the initial presentation was over two years in 50% (418) of gIIa and in 6.25% (1116) of gIIb patients (s.s. difference - p< 0.05). None of the patients with gIIa, but 37.5% (6116) with gIIb urothelial cancer had more than two recurrences (s.s. difference - p< 0.05). All gIIa recurred as gIIa superficial cancers, 62.5% (10116) of gIIb as gIIb (5 superficial and 5 invasive) and the remainder 37.5% (6116) as invasive gIII tumors. Only one patient with repeated recurrences died two years after the initial presentation. 3 patients died from other causes. In conclusion: 1. The morphological subdivision of gIl urothelial cancer into gIIa and gIIb has a prognostic significance, as it is related to the recurrence rate, the disease-free interval after the initial resection, the number of recurrences and the progression rate. 2. As gIIb urothelial cancer identifies patients at a higher recurrence risk. it is evident that this group requires an adjuvant treatment and a closer follow-up.