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Clinical Significance of the “Palpable Mass” in Patients with Muscle‐infiltrating Bladder Cancer Undergoing Cystectomy after Pre‐operative Radiotherapy
Author(s) -
FOSSÅ SOPHIE D.,
OUS S.,
BERNER A.
Publication year - 1991
Publication title -
british journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 0007-1331
DOI - 10.1111/j.1464-410x.1991.tb15070.x
Subject(s) - medicine , cystectomy , bladder cancer , radiation therapy , malignancy , stage (stratigraphy) , surgery , radiology , cancer , urology , paleontology , biology
Summary— Between 1976 and 1985, 132 patients with T2/T3/T4a bladder cancer underwent cystectomy after pre‐operative radiotherapy (46 Gy: 67 patients; 20 Gy: 65 patients). After a median time of 41 months, 62 patients were alive; 51 had died from recurrent bladder cancer and 19 from intercurrent disease without recurrence of their malignancy. Distant metastases developed in 40 patients, accompanied in 5 cases by local recurrence. Local recurrence was the first sign of relapse in 11 patients. In 3 patients the localisation of the relapse remained unknown. The corrected 5‐year survival rate was 60%. T category and a palpable bladder tumour were independent pre‐treatment prognostic factors in a Cox regression analysis, together with the interval between initial diagnosis and cystectomy. The presence of a palpable tumour before the start of treatment was associated with a particularly poor prognosis in T3/T4a tumours, whereas the survival of patients with non‐palpable T3/T4a tumours was similar to that of patients with T2 bladder cancer. Another important prognostic factor was post‐irradiation stage reduction (no residual muscle infiltration in the cystectomy specimen). Significantly more patients with nonpalpable bladder tumours experienced post‐radiation stage reduction than did those with a palpable tumour. However, the prognostic value of stage reduction was statistically significant only in patients with palpable bladder tumours.