A study on the prognosis of grade 3 bladder tumors following radical cystectomy

Twenty-three patients with transitional cell carcinoma of the bladder, grade 3 were treated by radical cystectomy between January 1986 and April 1998. A clinicopathological study on prognosis was carried out for these 23 patients. The overall survival rates were 95.7% for 1 year, 56.4% for 3 years, and 45.1% for 5 years. There was a significant difference in prognosis following radical cystectomy between the cases with stage pT3b or more higher stage tumors and those with stage pT3a or lower stage tumors (p<0.05). None of the patients with stage pT3b or invasive tumors survived for 5 years after surgery. There was a significant difference in prognosis between the cases with positive pV or pL and those with negative pV or pL (p<0.05, p<0.05). However there was no significant difference in prognosis between the cases with positive and negative pN. Distant metastasis and local invasion were observed in 1 patient with stage pT3a or lower stage tumors and in 8 patients with stage pT3b or higher stage tumors at a mean period of 14.5 months after surgery. The metastatic sites were usually the lung and bone. Distant metastasis and local invasion could be observed in the cases with positive pN earlier than cases with negative pN following radical cystectomy. These results suggest that positive pV, positive pL, and stage pT3b or higher stage tumors werfactors associated with poor prognosis. In particular, patients with stage pT3b or higher stage tumors should undergo any kind of adjuvant or neo-adjuvant therapy, since there are high rates of lymph node metastases in patients with stage pT3b or higher stage tumors.