Korean J Urol.  2010 Aug;51(8):525-530. 10.4111/kju.2010.51.8.525.

Efficacy of Bladder-Preserving Therapy for Patients with T3b, T4a, and T4b Transitional Cell Carcinoma of the Bladder

• Cheon J
• Chung H
• Song J

• KMID: 1997019
• DOI: http://doi.org/10.4111/kju.2010.51.8.525

Abstract

PURPOSE
Radical cystectomy has been the most widely used method in the treatment of bladder cancer, but it is limited by major problems. Therefore, we investigated the results of bladder-preserving treatment in patients with T3b, T4a, and T4b transitional carcinoma of the bladder who underwent transurethral resection of bladder cancer and subsequent administration of chemotherapy.
MATERIALS AND METHODS
Of all patients who were diagnosed with bladder cancer and underwent bladder-preserving treatment between January 2001 and August 2008, 78 patients with at least 12 months of follow-up data were enrolled in this study. All patients received gemcitabine (1,000 mg/m2) and cisplatin (70 mg/m2) once per month postoperatively for a total of 6 months and completed a follow-up visit every 3 months. The patient survival rate and prognostic factors (age, tumor size, differentiation, number of lesions, stage, and presence of hydronephrosis) were assessed. The Kaplan-Meier method was used to analyze survival rate, and Cox multiple regression analysis was used for prognostic factors.
RESULTS
The mean patient age was 68.32+/-8.6 years, the mean duration of follow-up was 54.70+/-32.8 months, and the median duration of follow-up was 49.0 months. The 5-year survival rate was 66.2%. Single lesions were found in 28 cases (35.9%), and multiple lesions were found in 50 cases (64.1%). Stage T3b lesions were identified in 56 cases (71.8%), stage T4a lesions were identified in 16 cases (20.5%), and stage T4b lesions were identified in 6 cases (7.7%). Tumor size was less than 4 cm in 4 cases (59.0%) and greater than 4 cm in 32 (41.0%). Hydronephrosis was present in 21 cases (26.9%). In the 5-year survival analysis, prognostic factors significantly influencing survival rate were T-stage of the tumor and absence of hydronephrosis and complete regression after treatment (p<0.05). Multivariate analysis revealed that tumor stage and the absence of hydronephrosis were statistically significant prognostic indicators.
CONCLUSIONS
In patients with T3b, T4a, and T4b transitional carcinoma of the bladder, bladder preservation may prevent a decrease in quality of life. Also, our findings suggest that this approach could be considered a primary treatment option for patients with T3b stage tumors without evidence of hydronephrosis.

Keyword

Drug therapy; Therapeutics; Urinary bladder neoplasms

MeSH Terms

Carcinoma, Transitional Cell
Cisplatin
Cystectomy
Deoxycytidine
Follow-Up Studies
Humans
Hydronephrosis
Multivariate Analysis
Quality of Life
Survival Rate
Urinary Bladder
Urinary Bladder Neoplasms
Cisplatin
Deoxycytidine

Figure

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  FIG. 1 Cumulative survival rate.

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  FIG. 2 Cumulative survival rate according to tumor stage.

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  FIG. 3 Cumulative survival rate according to hydronephrosis.

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