[Long-term effects on recurrence and mortality in superficial urothelioma of the bladder treated with endovesical chemotherapy].

BACKGROUND

To evaluate as the natural history of superficial bladder tumors is modified by intravesical chemotherapy and if the behavior of treated tumors allows to forecast subsequent tumoral evolution.

METHODS

125 patients with superficial bladder tumor Ta and T1 were submitted to transurethral resection (TURB) and additional chemotherapy for one year. Mean follow-up was of 92.2 +/- 39.8 months and all patients were observed for four years at least.

RESULTS

Efficacy of treatment was according to the literature: the median of recurrence was estimated about the 10th year (increase of free interval); the percentage of patients free from recurrence after 14 years of follow-up was 35 +/- 19.9, instead that of specific survival was 87.1 +/- 11.8 (inefficacy in a long period); the percentage of tumor related deaths was of 10.4 (inefficacy to avoid the progression). Regarding the risk factors present on the beginning, there was a significance for the T1 that relapsed in the 56.6% versus the 30.9% of the Ta (p = 0.012) and for the multiple tumors that relapsed in the 64.4% versus the 38.7% of the single one (p = 0.009). Also the time and the T category of the first recurrence were interesting factors for the subsequent evolution of disease. In fact, in the 47 patients at beginning T1 that relapsed, there was a 43.4% of tumor related deaths if the recurrence occurred in the first year of follow-up, versus the 12.5% if the recurrence occurred after the first year (p = 0.017). Furthermore the 61.9% of patients "non Ta" (T1 or Tis) to the first recurrence died for tumor but no one if the first recurrence was Ta (p = 0.000).

CONCLUSIONS

Intravesical chemotherapy is still reliable. It is able to increase the free interval of recurrence after TURB. Moreover it can offer a useful criterion to recognize patients with chemoresistant tumors at higher risk of progression.