Application of Scoring System Reflecting Various Prognostic Factors to the Prediction of Recurrence in Superficial Bladder Carcinoma

Choi, Chang Kyung; Kim, Jong Sung; Rim, Joung Sik

Abstract

PURPOSE: Although the conventional clinical, histopathological, and moleculobiological factors of bladder tumor provide a certain degree of stratification of tumor biological potential, it is difficult to make an accurate and reliable prediction of tumor recurrence with known prognostic factors due to tumor heterogeneity. So we attempted to devise a scoring system reflecting various prognostic factors to predict tumor recurrence more accurately in superficial bladder carcinoma.
MATERIALS AND METHODS
We reviewed retrospectively the clinical records and pathological specimens of 46 patients with superficial bladder cancer, who underwent transurethral resection of bladder tumor and intravesical Bacillus Calmette-Guerin (BCG) instillation between September, 1991 and December, 1996. The mean follow-up was 29 months. We examined the prognostic parameters such as tumor stage, grade, tumor with or without CIS, size, number, p53 expression and investigated the relation between the prognostic factors and the tumor recurrence. We assigned 1 and 2 for Ta and T1; 1 and 2 for tumor size(<3cm and > or =3cm); 1 and 2 for tumor number( < or =2 and > or =3); 1, 2 and 3 for grades( I, II and III); 2 if CIS is found and 1 if not; 2 if p53 is expressed more than 20%(strong positive) and 1 if p53 is not expressed or less than 20%(weakly positive). We summed the points assigned to all categories for each patient, and investigated tumor recurrence according to total points by the scoring system. We corrected the scoring system by deleting the insignificant prognostic factors in this study which was named the corrected scoring system. We recounted the points based on it.
RESULTS
Tumor recurred in 15 out of 46 patients(32.6%). Recurrence rate in patients with p53(strong positive) and with p53(weakly positive) was 47.3 and 18.5%, respectively (p<0.05). The recurrence rate of stage Ta and T1 was 40.0 and 30.6%(p>0.05) and that of grades I, II and III was 0, 20.8 and 55.6%(p<0.05), respectively. The recurrence rate of patients with and without CIS was 52.9 and 26.9%(p<0.05), respectively. The recurrence rate for patients with size of tumors > or =3cm and<3cm was 50 and 26.5%, respectively (p>0.05). Patients with number of tumors < or =2(22.6%) have a lower recurrence rate than those with tumors> or =3(53.3%)(p<0.05). p53 expression, high grade, tumor with CIS and number(> or =3) were considered as prognostic factors that affected the recurrence. For patients with summed points 4 to 9 based on the corrected scoring system, the recurrence rate was zero%(0/16) in patients with lower score(4 or 5), 31.8%(8/21) in those with intermediate score(6 or 7), and 77.8%(7/9) in those with higher score(8 or 9)(lower and intermediate score vs higher score: p<0.005).
CONCLUSIONS
The results suggested that this scoring system reflecting various prognostic factors can be a reliable method predicting the tumor recurrence. This scoring system awaits its application to more cases of bladder tumor and its refinement, if necessary.