A clinical study of total cystectomy for transitional cell carcinoma of the urinary bladder.

Fifty six patients with transitional cell carcinoma of the urinary bladder were treated by total cystectomy from January, 1979 through December, 1988. A retrospective study was conducted on 52 patients on whom prognosis could be followed up. There were 40 men and 12 women (male to female ratio: 3.3: 1), between 32 and 79 years old (mean age, 64.1 years old). The overall 1-, 3- and 5-year survival rates were 65.8%, 54.1% and 43.0%, respectively. The 5-year survival rates for patients with low grade (G, I, II) and high grade (G. III) were 41.9% and 42.7%, respectively: with no significant difference in the survival curves between the two groups. The 5-year survival rates according to histopathological stage were 78.9% for patients in low stage, 24.7% in high stage, and the difference in the survival curves between the two groups was statistically significant (P less than 0.001). The mortality in the 21 cases of the 33 high stage cases in which cisplatin was used was 42.9%, with 3- and 5-year survival rates were 53.1% and 36.8%, respectively. In the remaining 12 cases in which cisplatin was not used for post-operative chemotherapy, the mortality in the 12 cases was 83.3%, with 3- and 5-year survival rates of 25.1% and 12.3%, respectively. Thus, the patients who received post-operative chemotherapy showed a better survival rate than those who did not with a significant difference (P less than 0.05). The results of the present study suggest the usefulness of post-operative adjuvant chemotherapy in the high stage case.