The Prognostic Study Of T1G3 Bladder Cancer And The Establishment Of Prognostic Evaluation System

【Objective】Although being divided into not muscle-invasion bladder carcinoma,the clinical features of T1G3 bladder cancer were as similar as muscle-invasion bladder carcinoma's.There was much controversy about the therapy of the T1G3 bladder cancer.The ways to work out focus on how the prognosis of these patients was estimated exactly and objectiveIy.Only when the suitable strategy of therapy was applied,in some patients the conservative treatment(TURBt +adjuvant intravesical instillation)could control the cancer,but in others the early cystectomy must be used in order to gain the long term survival.In this research,we studied the prognosis of 213 cases of T1 G3 bladder cancer in our hospital from 1998 to 2006,and tried to formulate the tables of prognostic evaluation that allow urologists to easily calculate a T1G3 bladder cancer patient's short- and long-term risks of recurrence and progression after transurethral resection.【Methods】There are about 2300 cases bladder cancer patients in the urinary department of our hospital from 1998 to 2006.Among these patients 213 cases of T1G3 bladder cancer were affirmed pathologically after operation.The general state, clinical data,ways of treatment and pathological data of all the T1G3 bladder cancer patients were registered in sequence.The prognostic information about all the 213 patients was investigated with different ways.The expression of P53,FGFR3, E-cadherin,Ki-67 and MVD of all patients' paraffins samples were detected using immunohistochemistry.18 prognostic risk factors were planed to estimate in our study such as gender,age,the time from symptom emerging to visiting doctor, hydronephrosis,operation ways,immediately intravesical instillation,drug of intravesical instillation,tumor size,number of tumors,tumor modality,cancer in situ, the first recurrence time≤6m,frequency of recurrence,p53,FGFR3,E-cadherin, Ki-67,MVD.According the three different endpoints(recurrence,progression and death),the prognosis risk factors were preliminary screened respectively with Kaplan-Meier univariate analysis.And then the prognosis risk factors were determined finally with multivariate Cox proportional hazards regression model. Based on the coefficients of the variables in the multivariate model,a weight for each level of each variable was obtained and the prognostic evaluation score of T1G3 bladder cancer was calculated.【Results】187 cases of T1G3 bladder cancer entered the final statistics analysis after excluding the ineligible patients.1.Patient characteristics.In our study,the number of the T1G3 bladder patients occupied 9%of that of all the simultaneous bladder cancer patients.The male female ratio was 6:1.The average age was 66±19.6 years(35～92 years)and 50%was from 68 years to 78 years.Based on a average follow-up of 46 months and a maximum follow up of 111 months,100 cases of T1G3 bladder cancer recurred(61.3%),61 cases progressed(32.6%)and 37 cases died (19.8%).The 1 year,2 year,5 year probability of tumor recurrence was 35%,60%, 65%respectively with life table method estimating the accumulation probability.The 1 year,2 year,5 year probability of disease progression was 12%,27%,38%and the 1 year,2 year,5 year probability of death was 0,11%,26%respectively.2.The risk factors of the tumor recurrence of T1G3 bladder cancer included in the multivariate model were coded as:tumor size,number of tumors,immediately intravesical instillation,the first recurrence time≤6m,P53,FGFR3.The risk factors of the disease progression were coded as:tumor modality,cancer in situ,the first recurrence time≤6m,frequency of recurrence,P53,E-cadherin.Only progression was the risk factor of death.3.The tables of prognostic evaluation of tumor recurrence and disease progression of T1G3 bladder cancer were presented(See next page).【Conclusion】In this study,the risk factor of tumor recurrence and disease progression of T1G3 bladder cancer were determined with statistics method by investing the prognosis of 187 cases in our hospital.Based on this,the risk coefficient was translated into prognostic score and the tables of prognostic evaluation of T1G3 bladder cancer was founded initially,which shows the influence of each risk factor with intuitional scores.The model of prognostic evaluation of T1G3 bladder cancer could help the urologist to make a decision of the patients conveniently.