Multivariate analysis of progression in superficial bladder cancer.

A total of 217 patients with superficial bladder cancer (SBC) category Ta-T1 were retrospectively analysed for tumour progression and prognostic factors; 46% of patients presented with recurrences, 13% with increasing grades of anaplasia and 12% with progression in tumour category. The mean annual index of recurrences was 0.7 +/- 0.1; 4% of patients died from tumour progression and the overall 5-year survival rate was 88% +/- 5.3. Factors that influenced progression significantly were peritumoural dysplasia, inflammatory infiltrate, residual tumour following transurethral resections, increasing grade of anaplasia and index of recurrences > 0.7. Multivariate statistical analysis revealed that only tumour category and increasing grade of anaplasia had significant prognostic value. Increasing grade of anaplasia predicts the likelihood of tumour progression with a 91% global predictive capacity. Thirty percent of patients with tumour progression did not have an increasing grade of anaplasia. Among these 87% were Ta, 50% were GI and the mean index of recurrences was 0.9. All were conservatively treated and 87% are alive. Among the patients with an increasing grade of anaplasia and tumour progression the mean index of recurrences was 1.7; 67% developed muscle infiltrating cancer and 7% metastatic spread without local progression; 64% of these patients died from cancer. An increasing grade of anaplasia affects prognosis. It defines patients with a high risk of tumour progression and tumour-related death, especially those with T1 bladder cancer.